The Role of Sodium-Glucose Cotransporter 2 Inhibitors in Patients with Sarcoid Cardiomyopathy: A Multicenter Retrospective Cohort Study.

BACKGROUND

Cardiac involvement in sarcoidosis can manifest as new-onset heart failure (HF) due to inflammatory dilated cardiomyopathy (sarcoid cardiomyopathy [SCM]), conduction abnormalities, ventricular arrhythmias, and sudden death. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are known to improve HF outcomes and reduce mortality. Current guidelines endorse dapagliflozin and empagliflozin for HF management. However, their role in SCM is not known. This study evaluates SGLT2 inhibitors in patients with sarcoid cardiomyopathy and reduced left ventricular ejection fraction (LVEF).

METHODS

We utilized the TriNetX research network database from which we formed a cohort of patients with established SCM and a LVEF of less than 50%. Patients were divided into two groups on the basis of the presence or absence of SGLT2 inhibitors in their medical regimen. We analyzed the data for 12-month outcomes, including all-cause mortality, all-cause hospitalization, and HF hospitalization.

RESULTS

Propensity score matching yielded a total of 636 subjects with balanced baseline characteristics. Mean age was 60 ± 12 years, and 37% were female individuals. At 12 months, SGLT2 inhibitor use was associated with lower all-cause mortality (4.1 versus 8.8%, hazard ratio [HR] = 0.46, p = 0.019), total hospitalizations (HR = 0.79, p = 0.043), and HF hospitalizations (HR = 0.67, p = 0.016). Use of SGLT2 inhibitors was associated with a significant reduction in arrhythmic events (ventricular tachycardia, fibrillation, cardiac arrest, and second- or third-degree heart block) (HR = 0.59, p = 0.007) along with an improvement in LVEF.

CONCLUSIONS

SGLT2 inhibitor use is associated with improved outcomes in SCM with reduced LVEF, including lower mortality, hospitalization, and incidence of arrhythmic events. Our data support the use of SGLT2 inhibitors in this specific HF population.