Reverse cardiac remodeling and functional improvement with SGLT2 inhibitors in HFrEF: update from REWIN-HFrEF Study

Background

The use of SGLT2 inhibitors (SGLTi) has been shown to improve survival and reduce adverse events in patients with heart failure with reduced ejection fraction (HFrEF). Less is known on the role of SGLT2i to promote cardiac structure and function changes in this population.

Aims of the Study

1) to evaluate SGLT2i’s impact on cardiac function and structural remodeling in a cohort of real-world HFrEF ambulatory patients; 2) to evaluate possible different responses in SGLT2i therapy in HFrEF population.

Methods

We conducted a retrospective and prospective multicenter observational cohort study, consecutively enrolling 226 HFrEF ambulatory patients from February 2022 onward.

Baseline demographic, clinical, laboratory and echocardiographic parameters were collected at the time of enrollment and after six months of treatment with SGLT2i. All participants underwent conventional, tissue-derived imaging (TDI), and strain echocardiography both at baseline and after six months of treatment with SGLT2i.

Results

A total of 226 patients were enrolled, with a median age of 69 years and 38% of patients were female. Among these participants, 53% had a history of coronary artery disease, 57% hypertension, 39% chronic kidney disease, 20% type II diabetes mellitus; median left ventricular ejection fraction (LVEF) was 33,5%.

After six months follow-up several echocardiographic parameters resulted in statistically significant modifications: median ejection fraction increased from 33,5 to 35% (p < 0,001); left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) decreased respectively, from 179 to 155 mL, p < 0,001 and from 114 to 101 mL, p < 0,001; left ventricular end-diastolic diameter decreased (LVEDD) and left ventricular end-systolic diameter (LVESD) decresed respectively, from 63 to 62 mm, p=0,006 and from 55 to 53 mm, p=0,002; pulmonary artery systolic pressure (PAPs) decreased from 33,6 ± 9,8 to 32,3 ± 9,2 mmHg (p=0,032).

With regard to mitral, aortic and tricuspid functional regurgitation, a whole improvement was observed at symmetric measures Phi and Cramer’s V tests (p < 0,001).

Conclusions

Treatment with SGLT2 inhibitors showed a significant improvement in left ventricular function and cardiac reverse remodeling after 6 months of therapy in a cohort of real-world ambulatory HFrEF patients.