Key result
SGLT2 inhibitors linked to ~55% lower MACE risk after TAVI in high-risk diabetic patients.
Why the study?
A substantial number of diabetic patients with severe AS, LVEF < 50%, and EVCD undergoing TAVI experience adverse events, and the impact of SGLT2i on cardiac remodeling and long-term outcomes is unclear.
Does SGLT2i use reduce the composite of all-cause death and heart failure hospitalization in diabetic patients with severe aortic stenosis, LVEF < 50%, and extra-valvular cardiac damage undergoing TAVI?
Observational (n=311)
Yes
Does SGLT2i use reduce the composite of all-cause death and heart failure hospitalization in diabetic patients with severe aortic stenosis, LVEF < 50%, and extra-valvular cardiac damage undergoing TAVI?
Hazard Ratio: 0.45 (95% CI 0.17–0.75)
p-value: p=0.007
In diabetic patients with severe aortic stenosis, LVEF < 50%, and extra-valvular cardiac damage undergoing TAVI, SGLT2i use at discharge is associated with improved cardiac remodeling and a significantly reduced risk of death and heart failure hospitalization at 2 years.
BACKGROUND: A substantial number of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) experience adverse events after TAVI, with health care expenditure. We aimed to investigate cardiac remodeling and long-term outcomes in diabetic patients with severe AS, left ventricular ejection fraction (LVEF) < 50%, and extra-valvular cardiac damage (EVCD) undergoing TAVI treated with sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus other glucose-lowering strategies (no-SGLT2i users). 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.
No takes yet. Share an insight, caveat, or question.
Paolisso et al. (2024) conducted an observational in Type 2 diabetes mellitus with severe aortic stenosis, LVEF < 50%, and extra-valvular cardiac damage (n=311). Sodium-glucose cotransporter-2 inhibitors (SGLT2i) vs. Other glucose-lowering strategies (no-SGLT2i users) was evaluated on Composite of all-cause death and heart failure (HF)-hospitalization (MACE) at 2-year follow-up (HR 0.45, 95% CI 0.17-0.75, p=0.007). In diabetic patients with severe aortic stenosis, LVEF < 50%, and extra-valvular cardiac damage undergoing TAVI, SGLT2 inhibitor use reduced the risk of MACE (HR 0.45).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: