Abstract 12050: Dapagliflozin Therapy is Associated With Improved Left and Right Ventricular Function in Chronic Heart Failure Patients With Reduced Ejection Fraction

Abstract

Introduction: Although sodium-glucose transporter 2 inhibitors (SGLT2i) were shown to improve clinical outcomes of patients with heart failure with reduced ejection fraction (HFrEF), data on the effects of SGLT2i on myocardial function are scarce. Hypothesis: We evaluated the effects of dapagliflozin on left and right ventricular function in HFrEF patients. Methods: In a prospective sequential pilot clinical study we enrolled 14 HFrEF patients with NYHA II or III heart failure symptoms and LVEF<40%. In Phase I, all patients were treated with optimized heart failure therapy including sacubitril/valsartan, beta blockers and spironolacton. After 3 months, dapagliflozin (10 mg qd) was added to the regimen and the patients were followed for another 3 months (Phase II). At baseline, 3- and 6- month follow-up we collected clinical, biochemical and echocardiographic data. Renal dysfuntion was defined as eGFR<90 ml/min/1,73m 2 . Results: Of 14 patients, 10 (71%) were male; the average age was 57±16 years. Ishemic and non-ischemic heart failure was present in 3 (21%) and 11 (79%) of patients, respectively; 7 (50%) had renal dysfunction, 3 (21%) had diabetes and 6 (43%) had a history of hypertension. In Phase I we found no significant changes in LVEF (from 28±9% to 28±8%, P=0.91), left ventricular outflow tract VTI (LVOT VTI: from 12.8±3.6 cm to 13.3±5.3, P=0.80), or TAPSE (1.8±0.3 cm vs. 1.7±0.4 cm, P=0.62). Also, there were no significant changes in NYHA functional class (from 2.5±0.5 to 2.4±0.6, P=0.66), and NT-proBNP levels (from 1557±1745 pg/mL to 1677±1467 pg/mL, P=0.86). In contrast, in Phase II, we found a significant increase in LVEF (from 28±8% to 35±9%, P=0.02) and TAPSE (from 1.7±0.4 cm to 2.1±0.3 cm, P=0.04), and a trend of increase in LVOT VTI (from 13.3±5.3 cm to 16.7±3.4, P=0.07). In addition, after dapagliflozin therapy, we found a significant decrease in NYHA functional class (from 2.4±0.6 to 1.7±0.5, P=0.01) and NT-proBNP levels (from 1677±1467 pg/mL to 773±523, P=0.03). Conclusions: Dapagliflozin appears to improve echocardiographic parameters of left and right ventricular function in patients with HFrEF. Changes in heart function after dapagliflozin therapy occur in parallel with impovements in heart failure symptoms and levels of NTproBNP.