SGLT2-inhibitor therapy reduced the risk of all causes of syncope recurrence at 1 year in patients with type 2 diabetes and vaso-vagal syncope (HR 0.550; 95% CI 0.324-0.934).
Cohort (n=324)
Yes
Does SGLT2 inhibitor therapy reduce vaso-vagal syncope recurrence and improve autonomic function in patients with type 2 diabetes mellitus?
SGLT2 inhibitors are associated with improved cardiac autonomic function and reduced recurrence of vaso-vagal syncope in patients with type 2 diabetes.
Hazard Ratio: 0.55 (95% CI 0.324–0.934)
Background In patients with type 2 diabetes mellitus (T2DM) the vaso-vagal syncope (VVS) recurrence could be due to the alteration of autonomic system function, evaluated by heart rate variability (HRV), and by 123I-metaiodobenzylguanidine (123I-mIBG) myocardial scintigraphy indexes: Heart to Mediastinum ratio (H/M late ), and Washout rate (WR). The SGLT2-I could modulate/reduce autonomic dysfunction in T2DM patients with VVS. This effect could reduce the VVS recurrence in T2DM patients. Methods In a prospective multicenter study, after propensity score matching, we studied a population of 324 T2DM patients with VVS, divided into 161 SGLT2-I-users vs. 163 Non-SGLT2-I users. In these patients as SGLT2-I-users vs. Non-SGLT2-I users, we investigated the HRV and 123I-MIBG modifications and VVS recurrence at 12 months of follow-up. Results At follow-up end, the SGLT2-I-users vs. Non-SGLT2-I users had best glucose homeostasis and lower values of inflammatory markers, and resting heart rate ( p 0.05). At the Cox regression analysis H/M late (0.710, 0.481–0.985), and SGLT2-I therapy (0.550, 0.324–0.934) predicted all causes of syncope recurrence at 1 year of follow-up. Conclusions Non-SGLT2-I users vs. SGLT2-I-users had alterations of the autonomic nervous system, with a higher rate of VVS recurrence at 1 year of follow-up. The indexes of cardiac denervation predicted the VVS recurrence, while the SGLT2-I reduced the risk of VVS recurrence. Clinical trial registration number: NCT03717207.
Sardu et al. (Sun,) conducted a cohort in Type 2 diabetes mellitus with vaso-vagal syncope (n=324). SGLT2-inhibitors vs. Non-SGLT2-inhibitor users was evaluated on All causes of syncope recurrence (HR 0.550, 95% CI 0.324-0.934). SGLT2-inhibitor therapy reduced the risk of all causes of syncope recurrence at 1 year in patients with type 2 diabetes and vaso-vagal syncope (HR 0.550; 95% CI 0.324-0.934).