SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI)

Paolisso, P; Belmonte, M; Gallinoro, E; Scarsini, R; Bergamaschi, L; Portolan, L; Armillotta, M; Esposito, G; Moscarella, E; Benfari, G; Montalto, C; Shumkova, M; de Oliveira, EK; Angeli, F; Orzalkiewicz, M; Fabroni, M; Baydaroglu, N; Munafò, AR; D'Atri, DO; Casenghi, M; Scisciola, L; Barbieri, M; Marfella, R; Gragnano, F; Conte, E; Pellegrini, D; Ielasi, A; Andreini, D; Penicka, M; Oreglia, JA; Calabrò, P; Bartorelli, A; Pizzi, C; Palmerini, T; Vanderheyden, M; Saia, F; Ribichini, F; Barbato, E

doi:10.1186/s12933-024-02504-8

Type 2 & other diabetes

SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI)

Cardiovasc DiabetolPublished 21 Nov 2024Multicenter international registry study

An erratum to this article was published (Cardiovasc Diabetol, 13 Jan 2025 ↗)

Main finding · MACEResultHazard ratio 0.45 95% CI 0.17–0.75

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Authors' conclusion

In diabetic patients with severe AS, LVEF < 50%, and EVCD undergoing TAVI, the use of SGLT2i was associated with a more favorable cardiac remodeling and a reduced risk of MACE at 2-year follow-up.

Study context

Population: Diabetic patients with severe aortic stenosis, left ventricular ejection fraction (LVEF) < 50% and extra-valvular cardiac damage undergoing TAVI; 24% SGLT2i users
Participants: 311 patients

Exposure: SGLT2i vs other glucose-lowering strategies
Outcome: MACE: composite of all-cause death and heart failure (HF) hospitalization
Follow-up: 2-year follow-up

Methodological detailsconsecutive patients

Consecutive patients

Main finding

MACE

Hazard ratio

0.45

95% CI 0.17–0.75

P = 0.007

SGLT2ivs no-SGLT2i

HR 0.45 (95% CI 0.17–0.75); P = 0.007

As reported in the abstract

Observational data: associations, not effects.

Secondary outcomes

Outcome	← Lower risk with SGLT2i ←→ Higher risk with SGLT2i →	HR (95% CI)	P value
All-cause death · 2-year follow-upAdjusted for confounding factors	0.20.5125	0.51 (0.25–0.98)	P = 0.042
HF hospitalization · 2-year follow-upAdjusted for confounding factors	0.20.5125	0.40 (0.27–0.62)	P = 0.004
	0.20.5125Hazard ratio (log scale)

Outcome	P value
LV recovery · within 1 year after TAVISGLT2i vs no-SGLT2i · higher with SGLT2i, despite lower baseline LVEF	P = 0.032
LV recovery · within 1 year after TAVISGLT2i vs no-SGLT2i · subgroup baseline LVEF ≤ 30%; higher with SGLT2i	P = 0.026
Progression to a worse EVCD stageMore likely without SGLT2i	P = 0.018

Reference

Authors: Paolisso P, Belmonte M, Gallinoro E, Scarsini R, Bergamaschi L, Portolan L, et al.
All 38 authors
Paolisso P, Belmonte M, Gallinoro E, Scarsini R, Bergamaschi L, Portolan L, Armillotta M, Esposito G, Moscarella E, Benfari G, Montalto C, Shumkova M, de Oliveira EK, Angeli F, Orzalkiewicz M, Fabroni M, Baydaroglu N, Munafò AR, D'Atri DO, Casenghi M, Scisciola L, Barbieri M, Marfella R, Gragnano F, Conte E, Pellegrini D, Ielasi A, Andreini D, Penicka M, Oreglia JA, Calabrò P, Bartorelli A, Pizzi C, Palmerini T, Vanderheyden M, Saia F, Ribichini F, Barbato E
Journal: Cardiovascular Diabetology
Published: 21 Nov 2024
DOI: 10.1186/s12933-024-02504-8
PubMed: 39574095

Topic: Type 2 & other diabetes

Exposure definitions

SGLT2i: SGLT2i at hospital discharge

Key notes

SGLT2i use associated with a lower rate of MACE (p < 0.01)
Adjusted for confounding factors

Original publication

SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI). Cardiovasc Diabetol. Published 21 November 2024. doi:10.1186/s12933-024-02504-8

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