Why the study?
A substantial number of patients with severe AS undergoing TAVI experience adverse events after the procedure. The effect of SGLT2 inhibitors on cardiac remodeling and long-term outcomes in diabetic patients with severe AS and extra-valvular cardiac damage undergoing TAVI required investigation.
Does treatment with SGLT2 inhibitors 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?
Cohort (n=311)
Yes
Does treatment with SGLT2 inhibitors 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?
In diabetic patients with severe aortic stenosis, LVEF <50%, and extra-valvular cardiac damage undergoing TAVI, SGLT2i therapy was independently associated with improved cardiac remodeling and a significantly reduced risk of MACE, all-cause mortality, 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. Purpose We aimed to investigate cardiac remodeling and long-term outcomes in diabetic patients with severe AS 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.Summary of the main findings of the study.
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Vincelli et al. (2026) conducted a cohort in Severe aortic stenosis with extra-valvular cardiac damage, LVEF <50%, and diabetes mellitus undergoing TAVI (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 hospitalization (major adverse cardiovascular events, MACE) at 2-year follow-up (HR 0.45, 95% CI 0.17-0.75, p=0.007).
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