Abstract 14622: The Effects of SGLT2 Inhibitor Therapy in Patients With Non-Compaction Cardiomyopathy

Introduction: Current therapeutic options in patients with noncompaction cardiomyopathy (NCC) are very limited. Recent evidence suggests that sodium glucose co-transporter 2 inhibitors (SGLT2i) may be effective across the spectrum of heart failure.

Hypothesis: We sought to analyze the effects of SGLT2i on cardiac function in patients with NCC.

Methods: We have prospectively enrolled 30 (23 male, 7 female) patients with NCC, confirmed by cardiac MRI from 2020 to 2022. Clinical, biochemical and echocardiography data were obtained at SGLT2i introduction and 6-month follow-up. On inclusion the patients were on stable HF therapy; dapagliflozin 10mg was prescribed to 23 patients, empagliflozin 10 mg to 7 patients. On follow-up echo myocardial recovery was defined as an increase of left ventricle ejection fraction (LVEF) ≥5%.

Results: During follow-up, we found significant improvements in LVEF (29.8±7.5% vs. 43.5±9,5%; P<0.001), LVOT VTI (14.3±7.5cm vs. 17.6±9.7cm; P=0.005), E/e' (15.7±6.4 vs. 10,0±4.1, P<0.001) and TAPSE (2.0±0.4 vs. 2.3±0.4, P=0.012). NT-proBNP levels also decreased significantly (2843±3302 pg/mL vs. 582±803 pg/mL; P=0.002). A total of 18 (60%) of patients showed signs of myocardial recovery (Group A), whereas 12 (40%) showed no significant LVEF improvement (Group B); 5 patients had an event during follow-up (1 sudden cardiac death, 4 had heart Tx or LVAD implantation performed). The two groups did not differ significantly in age (50±15 vs. 46±15 years, P=0.54), sex (67% vs. 83 % male, P=0.28), baseline creatinine (83.3±27 μmol/Lvs. 89.3±21 μmol/L, P=0.53) or bilirubine (21±15 μmol/L vs. 17±12 μmol/L, P=0.56). When compared to Group B at inclusion, Group A had smaller EDD (6.4±0.8 cm vs. 7.1±0.9 cm in Group B, P=0.025), lower NTproBNP levels (1720±1662 pg/mL vs. 4527±4397 pg/mL, P=0.02), lower γGT levels (0.7±0.5 μkat/L vs. 1.4±1.1 μkat/L, P=0.017) and lower incidence of atrial fibrillation (11% vs. 57% in Group B, P=0.032).

Conclusions: In patients with NCC, the introduction of SGLT2i appears to be related to significant myocardial recovery. The improvement may be more pronounced in NCC patients with smaller LV diameter, less neurohormonal activation, better hepatic function and lower incidence of atrial fibrillation.