Outcomes of SGLT2 inhibitors after transcatheter mitral valve repair in patients with type 2 diabetes mellitus

BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2is) have demonstrated cardio- and renoprotective effects in patients with heart failure and type 2 diabetes mellitus (T2DM). However, their impact on patients undergoing transcatheter mitral valve repair (TEER) remains unclear. This study aimed to evaluate the effects of SGLT2i use and clinical outcomes in patients with T2DM undergoing TEER. METHODS: A multicenter retrospective analysis using the TriNetX Research Network identified adults with T2DM who underwent TEER between 2015 and 2023. Patients receiving SGLT2is at the time of TEER (n = 325) were propensity-score-matched 1 : 1 to a non-SGLT2i group (n = 325). The primary outcomes at 1 year included all-cause mortality, major adverse cardiovascular events (MACE; composite of acute myocardial infarction, cardiac arrest, acute heart failure, and ischemic stroke), acute kidney injury (AKI), and major adverse kidney events (MAKE; composite of stage 5 chronic kidney disease, end-stage kidney disease, dialysis dependence, or kidney failure). RESULTS: After matching, the cohorts were well balanced across most baseline characteristics, with a residual difference in baseline renal function (higher eGFR in the SGLT2i group). At 1 year, SGLT2i use was associated with lower all-cause mortality (15.1 vs. 20.0%; hazard ratio 0.68, P = 0.038) and reduced MAKE (6.2 vs. 11.7%; hazard ratio 0.47, P = 0.005). There were no significant differences in MACE (52.0 vs. 46.2%, P = 0.136) or AKI (31.7 vs. 32.9%, P = 0.737). CONCLUSION: Among patients with T2DM undergoing TEER, SGLT2i use was associated with significantly lower all-cause mortality and lower risk of MAKE at 1 year, despite similar rates of MACE and AKI. These findings support their potential renoprotective effects and overall survival benefits of SGLT2is in this high-risk population and warrant prospective validation.