Naslov
Left atrial strain is improved with addition vs. no addition of SGLT2 inhibitor to background heart failure pharmacotherapy among patients with HFrEF: a prospective cohort study with 3-month follow- up

Autori
Mustapić, Ivona ; Baković, Darija ; Sušilović Grabovac, Zora ; Glavaš, Duška ; Borovac, Josip Anđelo

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, prošireni sažetak, znanstveni

Skup
Heart Failure & World Congress on Acute Heart Failure 2023

Mjesto i datum
Prag, Češka Republika, 20.05.2023. - 23.05.2023

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
heart failure ; HFrEF ; LAS ; left atrial strain ; SGLT2 inhibitor ; dapagliflozin ; empagliflozin ; cardiac remodeling ; left ventricle ; global longitudinal strain ; atrial dysfunction ; OMT

Sažetak
Background: The left atrium is an important hemodynamic component and mediator of left ventricular diastolic dysfunction with its reservoir, conduit, and booster pump phases (1). It has been recently demonstrated that LA dysfunction is implicated in reduced survival among patients with decompensated heart failure (HF) (2). Similarly, left atrial strain (LAS) has been identified as an independent predictor for all-cause mortality and hospitalization in patients with HF (3). Purpose: The present study explored the potential impact of SGLT2i addition (empagliflozin or dapagliflozin 10 mg OD) to optimized medical therapy consisting of sacubitril-valsartan (Sac-Val), beta- blocker (BB), and mineralocorticoid receptor antagonist (MRA) on the left atrial function as reflected in LAS. Methods: A total of 37 outpatients with HFrEF in the NYHA II-III class were consecutively randomly assigned to SGLT2i+OMT (N=20) or OMT only (N=17) in the open-label fashion. All patients in both groups were using Sac-Val, BB, and MRA as a part of optimal medical treatment and these drugs were titrated to maximally-tolerated doses in both groups. A speckle-tracking echocardiography along with a standard echocardiographic examination were performed at 1st visit and control visit after 3 months of treatment initiation. A transthoracic echocardiography examinations were performed by the same expert sonographer blinded for treatment allocation. Results: A mean age of the enrolled population was 66.8±10.6 years and 27% (N=10) were women. Most of patients were in NYHA II functional class (73%) while the rest were in NYHA III class. The mean 3D left ventricular ejection fraction (LVEF) at baseline was 29.5±9.1% while mean left ventricular global longitudinal strain was -7.8%. The median NT-proBNP value in the whole cohort was 2789 pg/mL. About one-quarter of patients had diabetes mellitus (N=9, 24.3%), slightly less than half had dyslipidemia (N=17, 45.9%), 70.3% had arterial hypertension while more than a half (N=20, 54.1%) had a history of either percutaneous or surgical coronary revascularization. Both groups were well-matched with respect to age, sex, renal function, and comorbidities at baseline. Patients receiving OMT only exhibited a significant increase in LAS from baseline to 12-week examination (delta +2.5%, p=0.047 ; Figure 1A). However, patients receiving OMT with addition of SGLT2 inhibitor showed more pronounced increase in LAS from baseline to 12-week follow-up examination (delta +9.1%, p<0.001 ; Figure 1B). When compared head-to-head, the addition of SGLT2i to OMT was associated with a significantly greater increase in LAS during the observed period, compared to OMT alone (delta +6.5±2.7%, p=0.024 ; Figure 1C). Conclusion: The addition of SGLT2i to maximally tolerated OMT in outpatients with HFrEF was associated with a significantly improved left atrial function as measured by LAS, after the follow-up period of 3 months, compared to OMT alone.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

Napomena
The official annual congress of the HFA association of the European
Society of Cardiology.

POVEZANOST RADA