Background. The type-2 sodium-glucose cotransporters inhibitors (SGLT2i) are a new relevant therapeutic option for patients affected by chronic heart failure with reduced ejection fraction (HFrEF). The aim of this study was to evaluate the effects of SGLT2i on some clinical and biochemical parameters as well as the persistence of SGLT2i therapy up to 12 months.
Methods. We evaluated the consecutive patients affected by HFrEF in whom the SGLT2i therapy was prescribed since December 2021. The patients were followed-up after 1, 3, 6 and 12 months with a clinical visit, ECG, echocardiography, assessment of sodium, potassium, fasting glucose, hemoglobin, hematocrit and glomerular filtration rate (GFR) by creatinine. The data were analyzed by linear mixed models.
Results. Ninety patients were enrolled (age 60±9 years, 83% males, 20% diabetics, 38% affected by ischemic cardiomyopathy, NYHA class 2.24±0.43, 98% with ACEi/ARB/ARNi, 99% with beta-blockers, 84% with mineralcorticoid receptor antagonists).
During the follow-up SGLT2i therapy was well tolerated in most of the patients. Five patients withdrew the therapy, 2 for hypotension, 2 for poor adherence, 1 for genital infection.
As shown in the Figure, after SGLT2i therapy a significant reduction in weight and fasting glucose and a slight increase in LVEF were observed. Systolic arterial pressure did not show significant differences. As expected a significant short-term reduction in estimated GFR occurred, associated with a reduction of sodium serum levels. Hemoglobin and hematocrit progressively and significantly increased during follow-up.
Conclusions. In this “real world” study, among patients with HFrEF, the administration of SGLT2i resulted well tolerated in most of the patients. It was associated with the improvement of metabolic parameters (weight and fasting glucose), a slight temporary reduction in GFR, an increase in hemoglobin and systolic function. These data further support the use of this therapeutic approach in routine clinical practice.