SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI).
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Paolisso Pasquale, Belmonte Marta, Gallinoro Emanuele, Scarsini Roberto, Bergamaschi Luca, Portolan Leonardo, Armillotta Matteo, Esposito Giuseppe, Moscarella Elisabetta, Benfari Giovanni, Montalto Claudio, Shumkova Monika, de Oliveira Elayne Kelen, Angeli Francesco, Orzalkiewicz Mateusz, Fabroni Margherita, Baydaroglu Nurcan, Munafò Andrea Raffaele, D'Atri Daniele Oreste, Casenghi Matteo, Scisciola Lucia, Barbieri Michelangela, Marfella Raffaele, Gragnano Felice, Conte Edoardo, Pellegrini Dario, Ielasi Alfonso, Andreini Daniele, Penicka Martin, Oreglia Jacopo Andrea, Calabrò Paolo, Bartorelli Antonio, Pizzi Carmine, Palmerini Tullio, Vanderheyden Marc, Saia Francesco, Ribichini Flavio, Barbato Emanuele
Аннотация
METHODS: Multicenter international registry of consecutive diabetic patients with severe AS, LVEF < 50%, and EVCD undergoing TAVI. Based on glucose-lowering therapy at hospital discharge, patients were stratified in SGLT2i versus no-SGLT2i users. The primary endpoint was a composite of all-cause death and heart failure (HF)-hospitalization (major adverse cardiovascular events, MACE) at 2-year follow-up. Secondary outcomes included all-cause death, cardiovascular death, and HF hospitalization.
RESULTS: The study population included 311 patients, among which 24% were SGLT2i users. Within 1-year after TAVI, SGLT2i users experienced a higher rate of LV recovery (p = 0.032), especially those with baseline LVEF ≤ 30% (p = 0.026), despite the lower baseline LVEF. Patients not treated with SGLT2i were more likely to progress to a worse EVCD stage over time (p = 0.018). At 2-year follow-up, SGLT2i use was associated with a lower rate of MACE, all-cause death, and HF hospitalization (p < 0.01 for all). After adjusting for confounding factors, the use of SGLT2i emerged as an independent predictor of reduced MACE (HR = 0.45; 95% CI 0.17-0.75; p = 0.007), all-cause death (HR = 0.51; 95% CI 0.25-0.98; p = 0.042) and HF-hospitalization (HR = 0.40; 95% CI 0.27-0.62; p = 0.004).
CONCLUSIONS: In diabetic patients with severe AS, LVEF < 50%, and EVCD undergoing TAVI, the use of SGLT2i was associated with a more favorable cardiac remodeling and a reduced risk of MACE at 2-year follow-up.