Journal Article

147 Symptomatic benefit from sglt2 inhibition is independent of degree of lv reverse remodelling – a real world study

Dixon, Lana, Campbell, Michael, Agarwall, Pallavi, Savage, Patrick

2023

Overview

BackgroundSGLT2 inhibitors have quickly become established as a first line therapy for the treatment of heart failure with reduced ejection fraction (HFreF) (1). Furthermore, mounting evidence has highlighted their benefit across a range of ejection fraction; however, it is unclear whether their effect may be attenuated in patients who do not experience LV remodeling (2).AimWe sought to evaluate if symptomatic benefit from SGLT2 inhibition, as defined by quality of life (QoL) outcomes, occurred independently to reverse cardiac remodeling.MethodWe performed a retrospective data analysis of patients with HFrEF and HFpEF who were commenced on a SGLT2 inhibitor and underwent serial echocardiography.The primary endpoints were change in New York Heart Association (NYHA) score and left ventricular ejection fraction (LVEF) from baseline to six months.Data were extracted from local healthcare records. Data expressed as mean+/-standard deviation with p<0.05 defined as significant. Variance between groups analysed using paired students t test. Interaction of LV reverse remodeling on NYHA was assessed using a two-way repeated measures ANOVA. Statistical analysis performed using SPSS.ResultsA total of 73 patients commenced on a SGLT2i underwent serial echocardiography. Baseline demographics were similar between groups (Figure 1). At six months, 30 patients (70% male) had a significant improvement in LVEF (30.5+/-9.3% to 47.7+/-7.6%, p<0.01) and 43 patients (77% male) did not (33.8+/-9.4% to 34.8+/-8.3%, p=ns). In the static LVEF group, mean NYHA score was significantly improved at 6 months (2.3+/-0.9 to 2+/-0.7, p=0.02). Similarly, in the improved LV group there was a significant difference in NYHA score (1.9+/-0.8 to 1.5+/-0.6, p=0.03) (Figure 2). There was no significant interaction between LV reverse remodeling and degree of NYHA improvement (F[2, 22] =0.26, p=0.87, partial η2 =0.01).ConclusionThis data suggests that improvements in QoL markers of heart failure occur independently to reverse cardiac remodeling following treatment with SGLT2 inhibition. This suggests that mechanisms underpinning these effects may be independent to reverse cardiac remodeling.Abstract 147 Figure 1Bar graph demonstarting change in NYHA score following six months SGLT2i theraphy in patients with and without LV remodelling. In the static LVEF group, mean NYHA score was significantly improved at 6 months (2.3+/-0.9 to 2+/-0.7,p=0.02).Similarly,in the improved LV group there was a significant difference in NYHA score (1.9+/-0.8 to 1.5+/-0.6,p=0.03). There was no significant interaction between LV reverse remodelling and degree of NYHA improvement (F[2,22]=0.26,p=0.87,partial η2=0.01)Conflict of InterestNONE

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Ejection fraction / Heart Failure / Imaging / SGLT2i