Impact of SGLT2-inhibitors on cardiac function and structural changes in patients with heart failure and reduced ejection fraction - Results from the REWIN-HFrEF Study

The use of SGLT2 inhibitors has been shown to improve survival and reduce adverse events in patients with heart failure with reduced ejection fraction (HFrEF). Less is known on the role of SGLT2i to promote cardiac structure and function changes in this population.

To evaluate the impact of SGLT2 inhibitors on cardiac function and structural changes using both conventional and advanced echocardiographic parameters in a real-world cohort of ambulatory HFrEF patients.

We conducted a prospective multicenter observational cohort study, enrolling 151 consecutive patients with stable chronic HFrEF from February 2022 to June 2022.

Baseline demographic, clinical, and laboratory parameters were collected and subsequently re-evaluated at the six-month follow-up. Additionally, all participants underwent standard and advanced transthoracic echocardiography (including speckle-tracking analysis) both at the time of enrollment and after six months of treatment with SGLT-2i.

A total of 151 patients were enrolled, mean age was 70 ± 13 years, 28 (19%) were female. Baseline mean ejection fraction was 32 ± 6.6%. After six months of SGLT2-i therapy, mean ejection fraction increased from 32% to 35% (P: < 0.001). A trend towards improvement without statistical significance was also observed in global longitudinal strain (GLS) (from -10.37 ± 3.92% to -10.81 ± 4.12%) as well as in RV functional parameters (TAPSE: from 19.43 ± 3.85 mm to 19.67 ± 3.06 mm; S’TDI: from 9.93 ± 2.56 cm/sec to 10.12 ± 2.62 cm/sec; FAC: from 48.90 ± 9.94% to 49.32 ± 11.72%).

Statistically significant improvements were also found in LV end-diastolic and end-systolic volumes (LVEDV from 178.17 ± 62.69 mL to 161. 80 ± 57.16, P: < 0.001; LVESV from 122.33 ± 50.23 mL to 108.00 ± 46.23, P: < 0.001) and in right and left atrial volumes (respectively RAV from 54.63 ± 30.87 mL to 50.43 ± 27.68 mL P: 0.031; and LAV from 92.92 ± 41.92 mL to 86.19 ± 38.57, P: 0.009).

None of these parameters showed significant differential changes in diabetic compared to non-diabetic patients, nor in ischemic versus non-ischemic patients.

Treatment with SGLT2 inhibitors showed a remarkable improvement in left ventricular structure and function after 6 months of therapy in a cohort of real-world ambulatory HFrEF patients.