Impact of Dapaglizofin on right ventricular function and pulmonary pressure: a secondary analysis of the RIVED registry
A Palazzuoli, G Ruocco, S Franceschi, A Salzano, G C Crisci, M G Guazzi, P S Severino, F B Barilla', F M Mariano, F Dini, M F Di Santo, P Perrone Filardi, F Fedele, G Sorrentino, S GhioAbstract
Background
Right ventricular dysfunction (RVD) is an independent prognostic factors in patients with chronic heart failure (CHF), however poor evidence exist about the effect of current guideline directed medical therapy (GDMT) on RVD
Objectives
to investigate the effects of Dapaglifozin on right ventricle (RV) longitudinal function, RV pulmonary artery (PA) coupling, and pulmonary systolic pressure (PAPS), in CHF patients.
Methods
this is an exploratory open label prospective study including patients enrolled in a national multicenter observational trial randomized to Dapaglifozin (dapa group) or placebo (control group). Efficacy measures were changes from baseline to 6 months in RV end diastolic diameter (EDDRV) tricuspid annular peak systolic excursion (TAPSE) RV global longitudinal strain (RVGLS), fractional area (FA),systolic tissue doppler wave (S’), PAPS values, TAPSE/PAPS, and tricuspid regurgitation (TR).
Results
Over 6 months, the Dapa group showed significantly higher values of TAPSE at follow-up compared with controls (adjusted mean difference +1.03 mm, p < 0.001) and of S′ (adjusted mean difference +0.48 cm/s, p = 0.006). RVGLS at 6 months was significantly improved in the Dapa group (adjusted mean difference −1.54%, p < 0.001). TAPSE/PAPS ratio was higher in the Dapa group than in controls, with adjusted differences ranging from +0.07 to +0.17 across increasing baseline TAPSE/PAPS levels (all p ≤ 0.025). PAPS at 6 months was significantly lower in the Dapa group compared with controls, with a significant interaction with baseline PAPS (p for interaction = 0.047). Additionally, EDDRV was significantly lower in the Dapa group compared with controls (adjusted mean difference −1.54 mm, 95% CI −2.31 to −0.76, p < 0.001), this is associated with trend toward tricuspid regurgitation reduction (p<0.05).
Conclusions
Dapaglifozin treatment reveals beneficial effects on RV function together with PAPS and TR reduction. Current study may provide additional insights into the drug effects of on pulmonary circulation and RV myocardial contractility.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.