Dapagliflozin was well-tolerated and significantly reduced median NT-proBNP levels from 736.6 to 531.6 ng/L at 6 months in adults with systemic right ventricular failure.
Cohort (n=10)
No
Does dapagliflozin improve NT-proBNP levels and clinical outcomes in adults with congenital heart disease and systemic right ventricular failure?
Dapagliflozin was well-tolerated and associated with significant reductions in NT-proBNP and improvements in NYHA class in adults with congenital heart disease and systemic right ventricular failure.
Estimación del efecto: 17.3% reduction
Tasa de eventos absoluta: 531.6% vs 736.6%
valor p: p=0.012
Aims Given the compelling evidence on the effectiveness of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in the conventional heart failure population, SGLT2i deserve exploration in systemic right ventricular (sRV) failure. The initial experience with dapagliflozin in sRV failure patients is described, with a focus on tolerability and short-term effects on clinical outcomes. Methods and results Ten patients (70% female, median age 50 years 46.5–52) with symptomatic sRV failure who received dapagliflozin 10 mg per day on top of optimal medical therapy between 04–2021 and 01–2023 were included. Within 4 weeks, no significant changes in blood pressure, electrolytes, or serum glucose occurred. Creatinine and estimated glomerular filtration rate (eGFR) showed a slight decline (88 ± 17 to 97 ± 23 µmol/L, p = 0.036, and 72 ± 14 vs. 66 ± 16 ml/min/1.73m 2 , p = 0.020, respectively). At 6 months follow-up ( n = 8), median NT-proBNP decreased significantly from 736.6 589.3–1193.3 to 531.6 400.8–1018 ng/L ( p = 0.012). Creatinine and eGFR recovered to baseline levels. There were no significant changes in echocardiographic systolic sRV or left ventricular function. New York Heart Association class improved significantly in 4 out of 8 patients ( p = 0.046), who also showed an improvement in the 6-minute walk test or bicycle exercise test performance. One female patient developed an uncomplicated urinary tract infection. No patients discontinued treatment. Conclusion Dapagliflozin was well-tolerated in this small cohort of sRV failure patients. While the early results on the reduction of NT-proBNP and clinical outcome parameters are encouraging, large-scale prospective studies are warranted to thoroughly evaluate the effects of SGLT2i in the growing sRV failure population.
Neijenhuis et al. (Mon,) conducted a cohort in Systemic right ventricular failure in congenital heart disease (n=10). Dapagliflozin vs. Baseline (optimal medical therapy) was evaluated on Change in median NT-proBNP at 6 months (17.3% reduction, p=0.012). Dapagliflozin was well-tolerated and significantly reduced median NT-proBNP levels from 736.6 to 531.6 ng/L at 6 months in adults with systemic right ventricular failure.