Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Aug 20:54:101492.
doi: 10.1016/j.ijcha.2024.101492. eCollection 2024 Oct.

Left ventricular reverse remodeling after combined ARNI and SGLT2 therapy in heart failure patients with reduced or mildly reduced ejection fraction

Michele Correale  1 , Damiano D'Alessandro  2 , Lucia Tricarico  2 , Vincenzo Ceci  2 , Pietro Mazzeo  3 , Raffaele Capasso  2 , Salvatore Ferrara  4 , Massimo Barile  2 , Nicola Di Nunno  2 , Luciano Rossi  2 , Antonio Vitullo  2 , Michele Granatiero  2 , Mattia Granato  2 , Massimo Iacoviello  5 , Natale Daniele Brunetti  6
Affiliations

Left ventricular reverse remodeling after combined ARNI and SGLT2 therapy in heart failure patients with reduced or mildly reduced ejection fraction

Michele Correale et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Cardiac remodeling is an adverse phenomenon linked to heart failure (HF) progression. Cardiac remodeling could represent the real therapeutic goal in the treatment of patients with HF and reduced ejection fraction (HFrEF), being potentially reversed through different pharmacotherapies. Currently, there are well-established drugs such as ACEi/ARBs and β-blockers with anti-remodeling effects. More recently, ARNI effects on cardiac remodeling were also demonstrated; additional potential benefits of gliflozins remain non clearly demonstrated.

Aim of study: To evaluate possible changes in cardiac remodeling in patients with HFrEF/HFmrEF in treatment with ARNI or ARNI plus SGLT2i and the potential benefit on cardiac remodeling of adding SGLT2i to ARNI.

Methods: Between June 2021 and August 2023, 100 consecutive patients with HFrEF/HFmrEF underwent conventional and advanced echocardiography (TDI, 2DSTE): patients were therefore divided into three groups according to therapy with neither ARNI nor SGLT2i, just ARNI or both. After 3 months, all patients underwent echocardiographic follow-up.

Results: After a 3 months of therapy, significant improvements were observed for LVEF, LVEDD, LVEDV, LVESV, LV mass, E/e', LV GLS, TAPSE (ANOVA p< 0.01 in all cases), RV S' velocity (ANOVA p< 0.001).The trend in favor of additional treatment with SGTL2i over ARNI remained statistically significant even after multivariable analysis (p< 0.001 for LVEF, LVEDD; p< 0.01 for LV GLS, TAPSE, TRVS; p< 0.05 for LV mass).

Conclusions: SGLT2i therapy when added to the standard treatment for HFrEF and HFmrEF is associated with an improved biventricular function and ventricular dimensions at follow-up.

Keywords: Gliflozins; HFrEF; Heart failure; Remodeling; SGLT2i; Sacubitril/Valsartan.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Graphical representation of the subjects included in the study.
Fig. 2
Fig. 2
Changes of echocardiographic parameters and NT-proBNP at 3-month follow up.
Fig. 2
Fig. 2
Changes of echocardiographic parameters and NT-proBNP at 3-month follow up.
See this image and copyright information in PMC

References

    1. Di Lenarda A., Scherillo M., Maggioni A.P., Acquarone N., Ambrosio G.B., Annicchiarico M., Bellis P., Bellotti P., De Maria R., Lavecchia R., Lucci D., Mathieu G., Opasich C., Porcu M., Tavazzi L., Cafiero M. Temistocle InvestigatorsCurrent presentation and management of heart failure in cardiology and internal medicine hospital units: a tale of two worlds - the TEMISTOCLE study. Am. Heart J. 2003;146:E12. - PubMed
    1. Cohn J.N., Ferrari R., Sharpe N. Cardiac remodeling–concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an international forum on cardiac remodeling. J. Am. Coll. Cardiol. 2000;35:569–582. - PubMed
    1. Azevedo P.S., Polegato B.F., Minicucci M.F., Paiva S.A.R., Zornoff L.A.M. Cardiac remodeling: concepts, clinical impact, pathophysiological mechanisms and pharmacologic treatment. Arq. Bras. Cardiol. 2016;106:62–69. - PMC - PubMed
    1. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M., Burri H., Butler J., Čelutkienė J., Chioncel O., Cleland J.G.F., Coats A.J.S., Crespo-Leiro M.G., Farmakis D., Gilard M., Heymans S., Hoes A.W., Jaarsma T., Jankowska E.A., Lainscak M., Lam C.S.P., Lyon A.R., McMurray J.J.V., Mebazaa A., Mindham R., Muneretto C., Francesco Piepoli M., Price S., Rosano G.M.C., Ruschitzka F., Kathrine Skibelund A. ESC Scientific Document Group ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2021;2021(42):3599–3726. - PubMed
    1. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Böhm M., Burri H., Butler J., Čelutkienė J., Chioncel O., Cleland J.G.F., Crespo-Leiro M.G., Farmakis D., Gilard M., Heymans S., Hoes A.W., Jaarsma T., Jankowska E.A., Lainscak M., Lam C.S.P., Lyon A.R., McMurray J.J.V., Mebazaa A., Mindham R., Muneretto C., Francesco Piepoli M., Price S., Rosano G.M.C., Ruschitzka F., Skibelund A.K. ESC scientific document group focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur. Heart J. 2023;2023(44):3627–3639. - PubMed

LinkOut - more resources