Abstract
Purpose Multiple studies have shown improved cardiovascular outcomes with a sodium glucose-co-transporter 2 inhibitor (SGLT2i) in patients with heart failure with reduced ejection fraction (HFrEF). There are no current data supporting safety or efficacy in the Left Ventricular Assist Device (LVAD) population. The purpose of this study is to assess use of SGLT2 inhibitors in LVAD patients. Methods A retrospective analysis of LVAD patients implanted since 2015 was completed. Patients prescribed SGLT2i were identified. Clinical and laboratory variables were assessed following SGLT2i initiation with median values calculated at three and six month intervals. Results A total of 15 patients were prescribed SGLT2i, dapagliflozin (n=10) or empagliflozin (n=5), following LVAD implantation with follow-up time of 8 months (IQR 7-11). Six patients were naïve to SGLT2i until after implant, with 9 re-started on their pre-implant SGLT2i. Ten of the 15 carry a diagnosis of Diabetes Mellitus. Mean arterial pressure was 87 mmHg (IQR 82-88, n=15) at initiation, 78 mm Hg (IQR 74-89, n=15) at three months, and 82 mmHg (IQR 73-91, n=13) at six months. Estimated glomerular filtration rate was 70 mL/min/1.73m2 (IQR 54-92, n=15) at initiation, 79.5 mL/min/1.73m2 (IQR 60-94, n=12) at three months, and 74 mL/min/1.73m2 (IQR 62-78, n=9) at six months. Pro-brain natriuretic peptide decreased from 2005 pg/mL (IQR 1208-3813, n=13) at initiation, to 1334 pg/mL at 3 months (IQR 876-3617, n=11), and 885 pg/mL (IQR 409-1164, n=8) at 6 months. Glycated hemoglobin at the time of initiation was 7.4% (IQR 6.4-7.9, n=12), 7% (IQR 6.8-8.2, n=9) at 3 months, and 6.8% (IQR 6.5-7.3, n=6) at 6 months. One of the 15 patients had SGLT2i therapy discontinued due to recurrent genital yeast infections. Eight of the 15 patients had 11 total unplanned hospitalizations due to: gastrointestinal bleeding (2), acute decompensated heart failure (5), driveline infection (1), arrhythmia (1), drug-related reaction (1), diabetic ketoacidosis (DKA) (1). The hospitalization for DKA occurred while receiving high-dose steroids, and SGLT2i was resumed without adverse effects. Conclusion SGLT2i were successfully initiated in a small cohort of LVAD patients without significant adverse events. Larger, prospective studies are needed to determine if the cardiovascular and renal benefits of SGLT2i carry over from HFrEF to LVAD patients. Multiple studies have shown improved cardiovascular outcomes with a sodium glucose-co-transporter 2 inhibitor (SGLT2i) in patients with heart failure with reduced ejection fraction (HFrEF). There are no current data supporting safety or efficacy in the Left Ventricular Assist Device (LVAD) population. The purpose of this study is to assess use of SGLT2 inhibitors in LVAD patients. A retrospective analysis of LVAD patients implanted since 2015 was completed. Patients prescribed SGLT2i were identified. Clinical and laboratory variables were assessed following SGLT2i initiation with median values calculated at three and six month intervals. A total of 15 patients were prescribed SGLT2i, dapagliflozin (n=10) or empagliflozin (n=5), following LVAD implantation with follow-up time of 8 months (IQR 7-11). Six patients were naïve to SGLT2i until after implant, with 9 re-started on their pre-implant SGLT2i. Ten of the 15 carry a diagnosis of Diabetes Mellitus. Mean arterial pressure was 87 mmHg (IQR 82-88, n=15) at initiation, 78 mm Hg (IQR 74-89, n=15) at three months, and 82 mmHg (IQR 73-91, n=13) at six months. Estimated glomerular filtration rate was 70 mL/min/1.73m2 (IQR 54-92, n=15) at initiation, 79.5 mL/min/1.73m2 (IQR 60-94, n=12) at three months, and 74 mL/min/1.73m2 (IQR 62-78, n=9) at six months. Pro-brain natriuretic peptide decreased from 2005 pg/mL (IQR 1208-3813, n=13) at initiation, to 1334 pg/mL at 3 months (IQR 876-3617, n=11), and 885 pg/mL (IQR 409-1164, n=8) at 6 months. Glycated hemoglobin at the time of initiation was 7.4% (IQR 6.4-7.9, n=12), 7% (IQR 6.8-8.2, n=9) at 3 months, and 6.8% (IQR 6.5-7.3, n=6) at 6 months. One of the 15 patients had SGLT2i therapy discontinued due to recurrent genital yeast infections. Eight of the 15 patients had 11 total unplanned hospitalizations due to: gastrointestinal bleeding (2), acute decompensated heart failure (5), driveline infection (1), arrhythmia (1), drug-related reaction (1), diabetic ketoacidosis (DKA) (1). The hospitalization for DKA occurred while receiving high-dose steroids, and SGLT2i was resumed without adverse effects. SGLT2i were successfully initiated in a small cohort of LVAD patients without significant adverse events. Larger, prospective studies are needed to determine if the cardiovascular and renal benefits of SGLT2i carry over from HFrEF to LVAD patients.
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