Guideline-directed medical therapy in systemic right ventricle patients reduced adverse events and improved 6MWD (by ~68m) and sRV FWGLS at 3-year follow-up.
Does guideline-directed medical therapy reduce adverse events and improve functional capacity in adults with congenital heart disease and a failing systemic right ventricle?
Implementation of guideline-directed medical therapy, including ARNI and SGLT2 inhibitors, in adults with a failing systemic right ventricle is associated with reduced adverse events, improved exercise capacity, and better ventricular strain.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Adults with congenital heart disease(ACHD)with a systemic right ventricle(sRV) are at risk of developing heart failure(HF). Last guidelines have recommended a 4pillars-approach, including angiotensin receptor neprilysin inhibitor(ARNI)and sodium-glucose co-transporter2inhibitors(SGLT2i) together with betablockers(BB) and mineralcorticoid receptor antagonists(MRA) for HF with reduced ejection fraction. Aim of this study is to present our experience on the effects of guideline-directed medical therapy(GDMT)implementation in individuals with a failing sRV. Methods We retrospectively reviewed the medical records of all patients with a sRV attending our tertiary ACHD center from January2020 to January2025. A failing sRV was defined using a fractional area change cut-off≤35% measured by echocardiography. Any changes in pharmacological treatment were noted. Patients with univentricular physiology, SBP90mmHg, and a GFR25mL/min/1.73m2, as well as those on intermittent inotropic treatment were excluded. Data of any adverse events to the medication, including treatment discontinuation were collected. Baseline data including nt-proBNPvalues, 6-minute walking distance(6MWD) and sRV frewall global longitudinal strain(FWGLS)were compared to those collected at last follow-up. Results From the total population of 92patients with sRV followed at our ACHD unit, 70(76%) patients(mean age 40±12 years, 54%male) showed sRV dysfunction and were considered for GDMT:44(63%) patients with transposition of the great arteries(TGA)following atrial switch repair and 26(37%)with congenitally correctedTGA. Changes in pharmacological treatment are summarized in Figure1.ARNI was prescribed in 67(96%) patients. Forty-five(64%) patients were also started dapagliflozin 10mg daily following a mean of 17±8months from ARNI initiation, while 3patients initiated only SGLT2i and not ARNI. Mean FU was 2.9 ±0.9years. ARNI interruption was required in 5(7%) cases:2 patients stopped temporary the treatment during pregnancy, while 2 ceased ARNI due to hypotension and 1 to epigastrial discomfort. Dapagliflozin was stopped in 1 female patient due to recurrent urinary infections. During follow-up significant reduction in the incidence of adverse events including hospitalization for HF and sustained ventricular tachycardia/ICD therapies compared to three years preceding the treatment initiation(Figure 1). Moreover, GDMT was associated to increased 6MWD from 383.3±106 to 451±118 m;p0.0001 and improved sRV FWGLS from-15.5 ±5.2 to-17.4±3.2% at last follow-up;p=0.003, despite stable nt-proBNP values 237137-431 VS 249139-427pg/ml at latest follow-up, p=0.8. Conclusion Our experience in implementing GDMT for HF in patients with a sRV demonstrated that a4-pillars strategy is associated to a reduction of adverse events at3-year follow-up. Further prospective studies are required to ascertain whether those medications may also provide a positive impact on the outcome.
Altobelli et al. (Sat,) reported a other. Guideline-directed medical therapy in systemic right ventricle patients reduced adverse events and improved 6MWD (by ~68m) and sRV FWGLS at 3-year follow-up.