Sglt2 inhibitors and outcomes in patients with diabetes after durable lvad implantation: a multicenter real-world cohort study
H Wei, C C Yang, Y LinAbstract
Background
The prognostic impact of sodium–glucose cotransporter-2 inhibitors (SGLT2i) in patients with diabetes who underwent durable left ventricular assist device (LVAD) implantation remains unclear.
Purpose
To evaluate the association between SGLT2i therapy and cardiovascular and renal outcomes in LVAD recipients with diabetes during the chronic post-implantation phase.
Methods
Using the TriNetX Global Research Network, we identified adult patients with both diabetes and LVAD implantation (2014–2025). Exposure was defined as SGLT2i therapy (empagliflozin or dapagliflozin). A 90-day landmark analysis defined follow-up from 3 months to 1 year after LVAD implantation. The primary endpoint was major adverse cardiovascular events (MACE), defined as heart failure exacerbation (HFE) or all-cause mortality. Secondary outcomes were HFE, all-cause mortality, and major adverse kidney events (MAKE). Propensity score matching (1:1; caliper 0.1 SD) was applied before Cox proportional hazards analysis.
Results
After matching, 714 patients were included in each group. Compared with nonusers, SGLT2i users had significantly lower risks of MACE (HR 0.617; 95% CI 0.511–0.746; p<0.0001), HFE (HR 0.643; 95% CI 0.526–0.786; p<0.0001), and all-cause mortality (HR 0.599; 95% CI 0.395–0.907; p=0.0145). The risk of MAKE was numerically lower but not significant (HR 0.776; 95% CI 0.38–1.584; p=0.485). Findings were consistent across prespecified subgroups, with no safety signal observed.
Conclusions
Among LVAD recipients with diabetes who survived to the chronic post-implantation phase, SGLT2i therapy was associated with a substantially lower risk of MACE, driven by reductions in heart failure exacerbation and mortality. These real-world results support incorporating SGLT2i into post-LVAD pharmacologic optimization for patients with diabetes, pending validation in prospective studies.For image description, please refer to the figure legend and surrounding text.