Differential effects of sodium-glucose cotransporter 2 inhibitors and sacubitril-valsartan in incidence of heart failure with improved ejection fraction
M Moreira, I Bastos Castro, J Luis Ferraro, I Gomes Campos, A Rodrigo Costa, J Ponte Monteiro, I Almeida, A Leal Neto, A Pereira, P Silva, A AndradeAbstract
Introduction
Heart failure with improved ejection fraction (HFimpEF) is increasingly recognized as a meaningful phenotype. The impact of guideline directed medical therapy (GDMT) and its titration on HFimpEF incidence still needs to be clarified.
Methods
Single-center retrospective study with consecutive patients with chronic dilated cardiomyopathy and reduced ejection fraction from a heart failure clinic, between 2014-2024. Previous diseases, medication (including GDMT according to percentage of target dose), clinical status, biomarkers, electrocardiogram and echocardiogram findings were recorded. HFimpEF (left ventricle ejection fraction ≥40% with improvement of ≥10% from baseline) was the endpoint at 1-year post-admission.
Results
We included 189 patients (69.3% male; mean age 58.4±12.2 years-old), median LVEF of 26.8±10.7% at baseline. HFimpEF occurred in 37.1% of patients. Both at baseline and at 1-year, these patients were more likely to be on sodium-glucose cotransporter 2 inhibitors (SGLT2i) (66.1% vs 41.9%; p=0.002; 72.1% vs 51.4%; p=0.029, respectively) and on combined therapy with angiotensin-converting enzyme inhibitors (ACEi) or sacubitril-valsartan (ARNI), beta blocker (BB), SGLT2i and mineralocorticoid receptor antagonist (MRA), regardless of their doses (51.6% vs 34.4%; p=0.01; 62.3% vs 41.0%; p=0.008, respectively). Additionally, at 1-year, HFimpEF patients were also more often medicated with ARNI (60.7% vs 41.0%; p=0.014). A stronger association was evident for ARNI at target dose (37.7% vs 15.2%; p<0.001).
Conclusion
This study suggests that SGLT2i and ARNI, particularly when used at target dose, are the only HFrEF therapeutic pillars associated with HFimpEF in patients with dilated cardiomyopathy