Early hemodynamic impact of SGLT2 inhibitors in overweight cardiometabolic heart failure: beyond fluid offloading to vascular adaptation– a preliminary report
Authors' conclusion
Early hemodynamic responses to SGLT2i may differ across HF subtypes. In overweight patients with cardiometabolic HFpEF, our preliminary findings suggest an association with reduced vascular resistance, while in HFrEF/HFmrEF, the primary benefit appears to be volume unloading. However, the vascular effects of SGLT2i remain uncertain, and given the small sample size, these results should be interpreted as hypothesis-generating. Our findings also highlight the potential role of non-invasive hemodynamic monitoring in guiding therapy in HF.
Study context
- Population
- Consecutive heart failure (HF) patients receiving SGLT2i; median age 75 years, 70% overweight/obese, 4 with diabetes; 65% HFpEF, 25% HFmrEF, 10% HFrEFsingle group
- Participants
- 20 patients
- Exposure
- Baseline vs 4 weeks after SGLT2i start
- Outcome
- Hemodynamic and echocardiographic changes
- Follow-up
- Median 33 days [30-68]
Methodological detailssingle-center, preliminary report
- Single-center
- Preliminary report
Main finding
As reported in the abstract
- Body weight, 67.65 kg [46-99.20] to 65.50 kg [46.30-97]
- p = 0.027
- Systolic BP, 130 mmHg [100-150] to 116.50 mmHg [100-141]
- p = 0.015
- Total peripheral resistance index (TPRi), 3616.50 dynes·sec·cm³ [1600-5024] to 3098.50 dynes·sec·cm³ [1608-4684]
- p = 0.002
- Left atrial volume index, 42.84 ml/m² [27-69.40] to 41.15 ml/m² [26-62.60]
- p < 0.001
- Peak tricuspid regurgitation velocity, significant decrease
- p = 0.023
- Pulmonary artery systolic pressure (PASP), 31.0 mmHg (15.0-40.0) vs. 25.50 mmHg (15.0-38.0-)
- p = 0.010
Observational data: associations, not effects.
Further findings
Total body water, HFrEF or HFmrEF subgroup
- Significant reduction, 66.33 [51.45-74.45] vs. 58.68 [55.13-66.50]
TPRi, HFpEF subgroup (overweight/obese, n = 11, 79%)
- Significant reduction, 3681 dynes·sec·cm³ [1600-5024] vs. 3085 dynes·sec·cm³ [1608-4684]
- P = 0.005
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
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