Key result
SGLT2i therapy linked to reduced heart failure hospitalizations, BNP, and AVVR in single-ventricle CHD.
Why the study?
The impact of SGLT2i on invasive and non-invasive markers of cardiac function in pediatric patients with single ventricle heart disease needed evaluation.
Does sodium-glucose cotransporter 2 inhibitor therapy for >= 90 days improve markers of cardiac function and reduce heart failure hospitalizations in pediatric patients with single ventricle congenital heart disease?
Cohort (n=77)
No
Does sodium-glucose cotransporter 2 inhibitor therapy for >= 90 days improve markers of cardiac function and reduce heart failure hospitalizations in pediatric patients with single ventricle congenital heart disease?
In pediatric patients with single ventricle congenital heart disease, >= 90 days of SGLT2 inhibitor therapy was associated with significant reductions in qualitative AVVR severity, BNP levels, and heart failure hospitalizations.
Answers are grounded in this paper and cite their sources.
Should not yet change practice in pediatric single-ventricle CHD; leaves open whether randomized trials confirm SGLT2i benefit on HF hospitalizations.
This study evaluates the impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on pediatric patients with single ventricle (SV) heart disease, using invasive and non-invasive markers of cardiac function. We reviewed patients (< 21 years) with SV physiology who received ≥ 90 days SGLT2i at our center from 2020 to 2025. Baseline laboratory, echocardiographic, and hemodynamic data were recorded and compared to follow up data after ≥ 90 days on SGLT2i. Hospitalizations before and after SGLT2i were also analyzed. Seventy-seven patients with median age 10.5 years (range 47 days-19.9 years) had median treatment duration of 386 days (IQR 218-853). Among 62 patients (81%) with echocardiographic data (Fontan [39], Glenn [18], Stage 1 [5]) there was a significant decrease in median qualitative AVVR score from mild-moderate to mild (p = 0.01). Median BNP decreased from 84 pg/mL (IQR 18-274) to 42 pg/mL (IQR 18-105) (p = 0.02) and mean hemoglobin increased from 14.4 ± 2.5 g/dL to 15.5 ± 2.4 g/dL (p < 0.01). Ten patients had hemodynamic data without significant change in mean pulmonary artery pressure from 17 to 16 mmHg (p = 0.168) or ventricular end-diastolic pressure from 10 to 11 mmHg (p = 0.275). More patients had > 1 hospitalizations for heart failure during the 6-months prior to SGLT2i compared to the 6-months following initiation, with an odds ratio of 4.5 (95% CI: 1.6-13.7, p < 0.01). Overall, we identified significant reductions in AVVR, BNP, and hospitalizations for heart failure after ≥ 90 days of therapy. Further larger scale studies are needed to determine if SGLT2i will affect clinical outcomes in the pediatric SV population.
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Canova et al. (2026) conducted a cohort in Single ventricle congenital heart disease (n=77). Sodium-glucose cotransporter 2 inhibitors (SGLT2i) vs. Pre-treatment baseline (prior to SGLT2i initiation) was evaluated on Hospitalizations for heart failure (> 1 hospitalization in the 6 months prior vs 6 months following SGLT2i initiation) (OR 4.5, 95% CI 1.6-13.7, p=<0.01). SGLT2i therapy for >=90 days in children with single ventricle CHD reduced heart failure hospitalizations (pre- vs post-initiation OR 4.5; 95% CI 1.6-13.7; p<0.01), BNP (p=0.02), and AVVR (p=0.01).
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