Role of SGLT2I in improving right ventricular systolic function in patients with HFpEF

Background

Right ventricular (RV) dysfunction and RV–arterial uncoupling contribute substantially to symptoms and prognosis in heart failure with preserved ejection fraction (HFpEF). Although Sodium–glucose cotransporter 2 inhibitors (SGLT2 i) have demonstrated overall cardiovascular benefit, their specific impact on RV performance in HFpEF remains incompletely defined.

Purpose

To assess the effect of SGLT2 inhibitor therapy on right ventricular systolic function, strain parameters, and RV–PA coupling in patients with HFpEF.

Methods

In this prospective single-center study, 100 SGLT2 inhibitor–naïve HFpEF patients were initiated on SGLT2i therapy (at a dose 10 mg/day) and followed for six months. Clinical evaluation, NT-proBNP measurement, and detailed echocardiographic assessment including conventional RV systolic parameters, RV strain analysis and RV–PA coupling were performed before and 6-months after regular SGLT2i administration

Results

Thirty-five percent of patients had reduced RV global longitudinal strain (RV GLS <18%) at baseline. The cohort was predominantly female (82%), the mean age of patients was 64.55 ± 9.27 years and the mean body mass index (BMI) was 37.04 ± 7.21 kg/m2. Comorbidities included hypertension (96%), diabetes mellitus (52%), dyslipidemia (64%), and atrial fibrillation (53%).

After six months, the NT-proBNP levels significantly decreased (median 176.5 pg/mL and range 10940 pg/mL vs median 683 pg/mL and range 34772.1 pg/mL at baseline, p-value ≤0.001).

Echocardiography revealed a significant reduction in estimated pulmonary artery systolic pressure (25.25 ± 9.26 mmHg vs 36.32 ± 9.50 mmHg at baseline, p-value ≤0.001). Conventional RV systolic parameters improved significantly, including tricuspid annular plane systolic excursion (TAPSE) (26.89 ± 4.41 mm vs 24.64 ± 5.18 mm at baseline, p-value ≤0.001), fractional area change (51.34 ± 6.14 % vs 44.68 ± 6.62 % at baseline, p-value ≤0.001), and tricuspid annulus tissue Doppler S`-wave velocity (13.84 ± 2.30 cm/s vs 12.59 ± 2.36 cm/s at baseline, p-value ≤0.001).

Speckle-tracking analysis demonstrated significant improvement in RV GLS (-26.47 ± 5.59 % vs -20.63 ± 5.16 % at baseline, p-value ≤0.001) and RV free wall strain (-31.05 ± 6.21 % vs -26.99 ± 6.53 % at baseline, p-value ≤0.001). RV–PA coupling improved significantly (1.26 ± 0.61 vs 0.73 ± 0.28 at baseline, p-value ≤0.001), reflecting better ventriculo-vascular interaction.

Conclusion

SGLT2 inhibitor therapy was associated with significant improvement in RV systolic function, myocardial deformation, pulmonary pressures and RV–PA coupling in patients with HFpEF. These findings highlight a potential role of SGLT2 inhibitors in targeting right ventricular dysfunction and improving overall hemodynamic performance in HFpEF.Right ventricular function and RV-PA couplingRight ventricular function by STE