The effects of Dapagliflozin in a real-world population of HFrEF patients with different hemodynamic profiles: worse is better

Loria, F; Mone, P; Rispoli, A; Di Fonzo, R; Masarone, D; Mancusi, C; Correale, M; Vitullo, A; Granatiero, M; Mazzeo, P; Mercurio, V; Fiore, F; Di Sarro, E; Falco, L; Izzo, C; Campanile, A; Virtuoso, N; Stabile, E; Bonanno, S; Dattilo, G; Tocchetti, CG; Santulli, G; Vecchione, C; Ciccarelli, M; Visco, V

doi:10.1186/s12933-024-02515-5

Type 2 & other diabetes

The effects of Dapagliflozin in a real-world population of HF and reduced ejection fraction (HFrEF) patients with different hemodynamic profiles: worse is better

Cardiovasc DiabetolPublished 22 Nov 2024Prospective observational study

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Authors' conclusion

We demonstrate that Dapagliflozin is rapidly effective in an HFrEF real-world population; furthermore, the more significant effect is recorded in HFrEF patients with a congestive profile (B and D), supporting the introduction of Dapagliflozin in patients with a congestive profile and a worse prognosis. In conclusion, our data suggest evaluating the patient's hemodynamic state beyond LVEF in HFrEF.

Study context

Population: Patients with chronic HFrEF on optimal medical therapy, heart failure (HF) Clinics of 6 Italian University Hospitals, January 2022 to June 2023; classified into hemodynamic profiles A–D by SV and E/e'Dapagliflozin cohort
Participants: 240 patients

Exposure: Dapagliflozin added to optimal medical therapy vs retrospective GL 2012 and GL 2016 cohorts
Dapagliflozinn = 240
Outcome: Changes from baseline in Dapagliflozin population
Follow-up: 6 months

Methodological detailsmulticentre, comparison with two retrospective cohorts

Multicentre
Comparison with two retrospective cohorts

Main finding

As reported in the abstract

Significant improvement vs baseline in LVEF, LVEDV, LVEDV index, SVi, LAVi, E/e' ratio, TAPSE, RVs', FAC, IVC diameter, sPAP, NYHA class and quality of life
TAPSE and right ventricle diameter (RVD1) improved in congestive profiles (B and D); furosemide dose significantly decreased in these profiles

Observational data: associations, not effects.

Further findings

Rehospitalizations — Dapagliflozin vs GL 2012 · fewer with Dapagliflozin

p 0.0097

Dapagliflozin1.25%

GL 201218.89%

GL 201615.32%

Outcome	P value
RehospitalizationsDapagliflozin vs GL 2016 · fewer with Dapagliflozin	p 0.0497

sPAP change (baseline vs follow-up) across populations

Significant decrease of sPAP in Dapagliflozin population (p < 0.05); no changes in GL 2012 and GL 2016

Furosemide dose at baseline

GL 2012 and 2016 groups needed a significantly higher furosemide dose vs Dapagliflozin

Reference

Authors: Loria F, Mone P, Rispoli A, Di Fonzo R, Masarone D, Mancusi C, et al.
All 25 authors
Loria F, Mone P, Rispoli A, Di Fonzo R, Masarone D, Mancusi C, Correale M, Vitullo A, Granatiero M, Mazzeo P, Mercurio V, Fiore F, Di Sarro E, Falco L, Izzo C, Campanile A, Virtuoso N, Stabile E, Bonanno S, Dattilo G, Tocchetti CG, Santulli G, Vecchione C, Ciccarelli M, Visco V
Journal: Cardiovascular Diabetology
Published: 22 Nov 2024
DOI: 10.1186/s12933-024-02515-5
PubMed: 39578847

Topic: Type 2 & other diabetes

Exposure definitions

Dapagliflozin: HFrEF on optimal medical therapy (2021 ESC guidelines) with added Dapagliflozin
GL 2012: retrospective HF cohort treated per HF ESC guidelines in force at enrolment
GL 2016: retrospective HF cohort treated per HF ESC guidelines in force at enrolment

Original publication

The effects of Dapagliflozin in a real-world population of HFrEF patients with different hemodynamic profiles: worse is better. Cardiovasc Diabetol. Published 22 November 2024. doi:10.1186/s12933-024-02515-5

Read the original article ↗

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