SGLT2i therapy significantly reduced the apnea-hypopnea index from 21.17 to 18.10 (P<0.001) and improved right ventricular function and pulmonary pressure in patients with HFrEF and CSA.
Cohort (n=60)
Open-label
No
Does SGLT2i therapy improve right and left ventricular function and structure in patients with HFrEF and central sleep apnea?
In patients with HFrEF and central sleep apnea, 3 months of SGLT2i therapy significantly improved sleep apnea severity, right ventricular function, and pulmonary pressures, though structural parameters remained unchanged.
Absolute Event Rate: 18.1% vs 21.17%
p-value: p=< 0.001
Abstract Background Acute decompensate heart failure (ADHF) is commonly associated with central sleep apnea (CSA), contributing to nocturnal oxygen desaturation, elevated apnea-hypopnea index (AHI), and Cheyne-Stokes respiration (CSR), all of which exacerbate cardiac dysfunction. SGLT2i have demonstrated benefits for heart failure outcomes, renal protection, and sleep apnea symptoms. However, their impact on right-sided versus left-sided cardiac function and structure in patients with CSA remains inadequately studied. Aim To evaluate the effects of SGLT2i therapy on right versus left ventricular (RV vs. LV) function and structure in patients with heart failure with reduced ejection fraction (HFrEF) and CSA. Methods This prospective, open-label cohort study (January 2023 – November 2024) at the cardiology clinic of a university hospital included 210 consecutive patients with HFrEF and CSA. Inclusion criteria were: LVEF 40%, NT-proBNP 900 pg/ml, central AHI 5, and obstructive AHI 15. Exclusion criteria were end-stage renal disease, NYHA class IV, COPD, and severe respiratory failure. All patients were naive to SGLT2i therapy. Sleep apnea was diagnosed using the ApneaLink™ system, and echocardiographic evaluations were performed before starting SGLT2i. The follow-up period was three months. Results Following screening, 68 patients met the eligibility criteria. Of these, 3 patients withdrew from follow-up, and 5 patients passed away, resulting in a final cohort of 60 patients for analysis. Significant improvements were observed in sleep apnea and CSA parameters. AHI decreased from 21.17 ± 4.82 to 18.10 ± 4.63 (p 0.001), CSR frequency reduced from 32.6 ± 11.04 to 27.01 ± 9.61 (p 0.001), and the oxygen desaturation index (ODI) dropped from 24.35 ± 6.66 to 18.24 ± 5.83 (p 0.001). Echocardiographic analysis revealed significant changes in RV function and pulmonary pressure. sPAP decreased from 42.5 ± 6.3 to 41.01 ± 6.1 (p 0.001), TAPSE improved from 18.25 ± 2.20 to 19.1 ± 2.07 (p 0.001), and the TAPSE/sPAP ratio increased from 0.455 ± 0.11 to 0.47 ± 0.1 (p 0.001). Structural parameters of the right heart showed no significant changes: right atrial area (RAA) 21.93 ± 3.15 vs. 21.99 ± 3.04 (p=0.72) and right ventricular outflow tract 39.44 ± 4.17 vs. 38.52 ± 3.91 (p=0.08). For LV parameters, EF% remained stable at 35.06 ± 4.65 vs. 35.15 ± 4.84 (p=0.49). Diastolic function, measured by E/e', improved from 14.55 ± 2.76 to 13.75 ± 2.55 (p=0.03). Left ventricular end-diastolic volume (191.75 ± 19.20 vs. 189.77 ± 17.97, p=0.09) and left atrial volume index (45.58 ± 4.20 vs. 45.46 ± 4.24, p=0.239) showed no significant changes. Conclusion SGLT2i therapy reduced central sleep apnea episodes and improved functional parameters, particularly right ventricular function and pulmonary pressure, in patients with HFrEF and CSA. Larger cohorts are needed to assess potential structural changes.
Kalaydzhiev et al. (Sat,) conducted a cohort in Heart failure with reduced ejection fraction (HFrEF) and central sleep apnea (CSA) (n=60). SGLT2i therapy vs. Baseline (pre-treatment) was evaluated on Apnea-hypopnea index (AHI) (p=< 0.001). SGLT2i therapy significantly reduced the apnea-hypopnea index from 21.17 to 18.10 (P<0.001) and improved right ventricular function and pulmonary pressure in patients with HFrEF and CSA.