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SGLT2 inhibitors in heart failure with reduced ejection fraction: their biological properties goes well beyond a smart diuretic effect
Session:
Posters (Sessão 6 - Écran 4) - Insuficiência Cardíaca 6 - Inibidores SGLT1
Speaker:
Pedro Alves Da Silva
Congress:
CPC 2022
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.4 Chronic Heart Failure – Treatment
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Pedro Alves da Silva; João r. Agostinho; Sara Couto Pereira; Pedro Silvério António; Rafael Santos; Joana Brito; Beatriz Valente Silva; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Simões de Oliveira; Joana Rigueira; Doroteia Silva; Nuno Lousada; Fausto j. Pinto; Dulce Brito
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Latest ESC heart failure (HF) guidelines added SGLT2i to the foundational therapy of chronic HFrEF, based on trials that showed that SGLT2i on top of standard care led to a reduction on HF hospitalizations and cardiovascular mortality. However, pathophysiological mechanisms responsible for these benefits are still a matter of debate, as some authors postulate that its diuretic properties have a central role and others emphasize its metabolic effects that could lead to reverse cardiac remodelling. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives: </strong>To compare echo and laboratorial surrogates of diuresis and cardiac remodelling before and after SGLT2i initiation as a mean to hypothesize which mechanism predominantly leads to HF events reduction. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Single-center, retrospective study of pts with HFrEF followed in a HF unit in a tertiary center. Data regarding epidemiologic, clinical and echo parameters were recorded before and after SGLT2i initiation. Surrogate markers of diuresis and cardiac remodeling variation and its impact were evaluated using Wilcoxon Test, Cox Regression and Kaplan-Meier analysis. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We included 176 pts with HFrEF started on SGLT2i. Mean age was 66.5±12 years, 70.5% male. Most had ischemic (51.1%) or dilated cardiomyopathy (38.6%) with mean left ventricular ejection fraction (LVEF) of 31±9.7%. 89% were in NYHA class I or II, and mean NTproBNP was 2737±4008pg/mL.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">After a mean follow-up (FUP) of 1.38±1.59 years we saw no statistical difference between characteristics often used as surrogates for diuresis, namely weight, hematocrit, creatinine or sodium (p=NS) – Table 1. Interestingly, we did find a significant difference concerning LVEF (31±9,7% vs 34,1±11,2%; p=0.001), NTproBNP (2737±4008pg/mL vs 2258±5204pg/mL; p <0.001) and filling pressures evaluated by mean E/e’ (14.4±8.6 vs 11.7±5.6; p=0.017).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During FUP, 11.4% pts were hospitalized, 9.7% had outpatient treated HF decompensations and 1,1% died. Lower LVEF<35% and higher NTproBNP (>786pg/mL) correlated with events (HR 3.197, 95% CI 1.492-6.850, p = 0.003; HR 4.631, 95%CI 1.905-11.263, p = 0.001) in contrast to hematocrit or Hb levels (P=NS). No impact was estimated with mean E/e’.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>These data support the hypothesis that iSGLT2 effects go beyond its diuretic properties and extend to anti-remodeling processes, as noted by differences in NTproBNP, LVEF and diastolic function. Such processes have significant impact on prognosis and events during FUP, reinforcing the importance of the new foundational therapy.</span></span></p>
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