Association of sodium-glucose cotransporter-2 inhibitors with outcomes in patients with moderate or severe aortic stenosis and acute heart failure: data from a prospective cohort study
D Kosmidis, D Vatitsis, E Sotiroglou, K Solaki, A Michailidou, M Sitmalidou, N Gouliaros, T Sertis, C Stefanidis, C ChatzieleftheriouAbstract
Background/Introduction
In the recently published DapaTAVI randomised clinical trial, dapagliflozin was found to reduce the incidence of death from any cause or worsening heart failure (HF) in older patients with aortic stenosis undergoing transcatheter aortic valve implantation.
Purpose
The aim of the current study was to explore the association of in-hospital initiation and out-of-hospital continuation of a sodium-glucose cotransporter-2 inhibitor (SGLT2i) with outcomes in adult patients with moderate or severe native aortic valve stenosis (AoS) hospitalised for acute HF.
Methods
This was a sub-analysis of a prospective, observational, cohort study of all consecutive adults hospitalised for acute de novo or acute decompensated HF between August 2023 and January 2026. A comprehensive transthoracic echocardiogram was conducted within the first 24 hours since admission and the patients with moderate or severe native AoS according to the EACVI guidelines were included in the final analysis. All-cause mortality or HF re-hospitalisation was defined as the primary composite outcome. Kaplan-Meier curves were used to compare the freedom from the composite outcome in AoS patients who received a SGLT2i versus the non-receivers. Univariate and multivariable Cox-regression analyses were also used.
Results
Out of 336 individuals hospitalised for acute HF, 48 patients with moderate or severe native AoS were included (mean age 85 years, 75% female). The median value of ejection fraction was 50% and the majority of included patients were classified as having HF with preserved ejection fraction. During a median follow-up of 1 year, the composite outcome occurred in 48% of patients (n=23). AoS patients who received a SGLT2i exhibited better freedom from the composite outcome compared to non-receivers (Figure 1; p=0.033, log-rank test). Multivariable regression analysis demonstrated that the non-receivers had a 3-fold risk of all-cause mortality or HF re-hospitalisation adjusted for other HF pharmacotherapies, type of HF, age and significant (at least moderate) mitral regurgitation (Figure 2; adjusted hazard ratio: 3.1, p=0.037).
Conclusions
In patients with moderate or severe native AoS hospitalised for acute HF, in-hospital initiation and out-of-hospital continuation of SGLT2i was associated with a lower probability for all-cause mortality or HF rehospitalisation.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.