Elsevier

The American Journal of Cardiology

Volume 188, 1 February 2023, Pages 80-86
The American Journal of Cardiology

Efficacy of SGLT2 Inhibitors in Patients With Diabetes and Nonobstructive Hypertrophic Cardiomyopathy

https://doi.org/10.1016/j.amjcard.2022.10.054Get rights and content

The objective of this study was to evaluate the effects of sodium glucose co-transporter 2 inhibitors (SGLT2i) on functional capacity and diastolic function in patients with diabetes with nonobstructive hypertrophic cardiomyopathy (nHCM) and preserved left ventricular (LV) function. From January 2019 to October 2020, a prospective open-label study was performed on patients with type 2 diabetes mellitus and nHCM with New York Heart Association class II-III symptoms. Patients with a LV ejection fraction <50% were excluded. Patients were recruited from January 2019 to November 2019 to the SGLT2i arm and from November 2019 to October 2020 to the control arm. The primary composite end point was defined as achieving an improvement of at least 1.5 in E/e′ and a reduction of ≥1 New York Heart Association functional class after 6 months of therapy. At baseline, there were no significant differences between the SGLT2i (n = 24) and control arms (n = 24). More patients in the SGLT2i arm achieved the primary end point than the patients in the control arm (70.8% vs 4.2%, p <0.001). After 6 months of therapy, patients in the SGLT2i arm showed a significant improvement in all diastolic function parameters (E/e′ 16.3 ± 1.9 vs 13.3 ± 1.6, p <0.001; E/A 2.8 ± 0.1 vs 2.4 ± 0.1, p <0.001; left atrial volume 45.6 ± 5.2 vs 40.8 ± 4.9 ml/m2, p = 0.003). There was also an improvement in the 6-minute walk distance (295.1 ± 31.5 vs 343.0 ± 31.1 m, p <0.001) and N-terminal pro-B-type natriuretic peptide (481.4 ± 52.6 vs 440.9 ± 43.9 pg/ml, p <0.001) in patients who received SGLT2i. There was no significant change in the LV mass in the SGLT2i or control arm (−0.1 ± 0.3 vs 0.1 ± 0.5 g/m2, p = 0.319) after 6 months of therapy. A patient in the SGLT2i arm discontinued therapy because of a urinary tract infection. In conclusion, the use of SGLT2i improved diastolic function and functional capacity in patients with diabetes with nHCM and a preserved LV function.

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SGLT2i therapy in patients with diabetes with nonobstructive hypertrophic cardiomyopathy with a preserved left ventricular function: an open-label study.

In this open-label study, the administration of sodium glucose co-transporter 2 inhibitors, on top of optimal medical treatment, to patients with diabetes with nonobstructive hypertrophic cardiomyopathy improved diastolic function, N-terminal pro-B-type natriuretic peptide, ameliorated New York Heart Association functional class, and enhanced exercise capacity.

Section snippets

Methods

A prospective, open-label, blinded end point trial was performed to determine whether SGLT2is could improve diastolic function and functional capacity in patients with nHCM. Consecutive patients were screened and recruited from the Institutional Hypertrophic Cardiomyopathy Clinic between January 2019 and October 2020. The trial was approved by the institutional ethics committee, and the participants provided written informed consent before enrollment. The study was conducted according the

Results

From January 2019 and October 2020, 52 patients with an HCM phenotype were initially screened. Figure 1 summarizes participant flow during the study. A patient discontinued SGLT2 treatment during the study because of drug-related adverse effects but completed the study visits through 6 months. Of the screened patients, 1 did not satisfy the inclusion criteria and the other refused to participate.

Patient demographics and baseline clinical variables are shown in Table 1. Of the 48 recruited

Discussion

This study evaluated the effects of SGLT2i in patients with diabetes mellitus and nHCM. The main findings of this study were: (1) the addition of SGLT2i to standard HF therapy improved diastolic function and NYHA functional class, (2) there was concomitant improvement in 6-minute walk distance and NT-proBNP levels, and (3) treatment with SGLT2i was safe and well tolerated in most patients. To the best of our knowledge, this is the first report evaluating the efficacy of SGLT2i in patients with

Disclosures

The authors have no conflicts of interest to declare.

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  • Cited by (0)

    Drs. Sravani, Krishna, and Bijjam contributed equally to this work.

    Funding: None.

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