Heart Failure and Tricuspid Regurgitation: The Role of SGLT2 Inhibitors in Improving Outcomes

Figures

• 

  Figure 1. Kaplan-meier curves for the cumulative incidence of the primary outcome stratified by baseline TR status. Kaplan-Meier cumulative incidence curves of the composite outcome in the study population before applying IPTW, demonstrating a higher incidence of mortality or HF hospitalization among patients with HF and significant TR. Log rank P < 0.001. HF = Heart Failure; TR = Tricuspid Regurgitation.

• 

  Figure 2. Kaplan-meier curves for the cumulative incidence of the primary outcome by baseline SGLT2i use in patients with and without significant TR. Kaplan-Meier cumulative incidence curves of the composite outcome in the pseudopopulation after applying IPTW, demonstrating that the association between SGLT2i use and lower risk for mortality or HF hospitalization does not depend on TR status. A: In patients with significant TR (n = 4156), the incidence of the composite utcome was 24% vs. 45.7% in SGLT2i treated vs. untreated patients. B: In patients without significant TR (n = 24 872), the corresponding rates were 13.8% vs. 28.6%. Log rank P < 0.001 for both. HF = Heart Failure; SGLT2i = Sodium-Glucose Cotransporter-2 inhibitors; TR = Tricuspid Regurgitation.

• 

  Figure 3. Forest plot of hazard ratios for SGLT2i use in patients with and without significant TR across multiple sensitivity analyses. This forest plot presents the hazard ratios and corresponding 95% confidence intervals for the association between SGLT2i use and the primary composite outcome, stratified by the presence (blue) or absence (red) of significant TR in multiple sensitivity analyses and one-year landmark analysis. Absolute event rates are shown, and all estimates originate from a multivariable time-dependent model. The findings demonstrate that overall, SGLT2i use is associated with a consistent reduction in risk of HF hospitalization and mortality among patients with and without significant TR despite the exclusion of key subgroups, with various degrees of interaction, in a multivariable model. Undertreated patients are defined as HF patients who received fewer than two medications, including BB, MRA, and ACEi/ARB/ARNi. CKD = Chronic Kidney Disease; DM = Diabetes Mellitus; HF = Heart Failure; HTN = Hypertension; RV = Right Ventricle; SGLT2i = Sodium-Glucose Cotransporter-2 inhibitors; TR = Tricuspid Regurgitation; VHD = Valvular Heart Disease; V-STR = Ventricular-Secondary TR.