Echocardiographic effects of sodium-glucose cotransporter 2 inhibitors in single ventricle circulatory failure

Figures

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  Fig. 1. Title. TTE assessment methodology Fig. 1Caption. The top part of figure (A–E) shows the ventricular function assessment in a patient with tricuspid atresia and a left ventricle dominant Fontan circulation, the bottom part (F–J) in a patient with congenitally corrected transposition of the great arteries, double-outlet right ventricle, subaortic ventricular septal defect, and pulmonary atresia, palliated with a Glenn shunt and Blalock-Thomas-Taussig shunts. A&F) end-diastolic area (cm2), B&G) end-systolic area (cm2) and FAC calculation, C&H) strain analysis including GLS, segmental strain values, and calculation of the FWS by averaging the 3 lateral strain segments, D&I) tissue Doppler imaging measurements S’ (measurement 1, m/s), e’ (measurement 2, m/s), and IVA (slope measurement 3, m/s2), E&J) E and A velocities (m/s) measured on (at least) two complexes on pulsed-wave Doppler. FAC, fractional area change; FWS, free wall strain; GLS, global longitudinal strain; IVA, isovolumic acceleration; RV, right ventricle; RVA, right ventricle area; TTE, transthoracic echocardiography.

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  Fig. 2. Title. Changes in end-systolic area and FAC after starting SGLT2i Fig. 2Caption. A) End-systolic area decreased significantly in the first 100 days after starting SGLT2i (−1.6 cm2 per month, p = 0.007), after which there was an increasing trend (0.6 cm2 per month, p = 0.051). B) Patients with SVFrEF had a significant improvement in FAC in the first 100 days (3.5 %-point per month, p < 0.001), after which the change was not significant (p = 0.141). SVFpEF patients had a significantly different trajectory from the SVFrEF patients and remained stable in the first 100 days (−0.1 %-point per month, interaction p = 0.007), after which the change was no longer significantly different between groups (interaction p = 0.081). FAC, fractional area change; FU, follow-up, SGLT2i, sodium-glucose cotransporter 2 inhibitor; SVF, single ventricle failure, SVFrEF/SVFpEF, single ventricle failure with reduced/preserved ejection fraction.

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  Fig. 3. Title. Changes in FWS and basal lateral strain after starting SGLT2i Fig. 3Legend. A) Predicted longitudinal changes in FWS (%) after starting SGLT2i. There was a significant improvement in FWS over time (−0.3 %-point per month, p = 0.036). SVFpEF patients had significantly better strain values (4.7 %-point lower than SVFrEF patients, p = 0.003). B) Predicted longitudinal changes in basal lateral segmental strain (%). There was a significant improvement over time (−0.3 %-point per month, p = 0.032), and SVFpEF patients also had significantly better basal lateral segmental strain (7.6 %-point lower than SVFrEF patients, p = 0.006). FU, follow-up; FWS, free wall strain; SGLT2i, sodium-glucose cotransporter 2 inhibitor; SVF, single ventricle failure, SVFrEF/SVFpEF, single ventricle failure with reduced/preserved ejection fraction.

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  Fig. 4. Title. Changes in IVA after starting SGLT2i Fig. 4Legend. There was a significant improvement in IVA in the first 100 days after starting SGLT2i (0.5 m/s2 per month, p = 0.010), after which there was a decreasing trend (−0.2 m/s2 per month, p = 0.075). SVFrEF patients had a significantly lower overall IVA than SVFpEF patients (1.3 cm2, p = 0.027). FU, follow-up; IVA, isovolumic acceleration; SGLT2i, sodium-glucose cotransporter 2 inhibitor; SVF, single ventricle failure, SVFrEF/SVFpEF, single ventricle failure with reduced/preserved ejection fraction.