Department of Cardiology, Faculty of Medicine, Giresun University, 28100 Giresun, Turkey.
Medicina (Kaunas). 2022 Aug 19;58(8):1128. doi: 10.3390/medicina58081128.
Background and Objectives: In addition to left ventricular (LV) functions, right ventricular (RV) functions and pulmonary arterial stiffness (PAS) may be adversely affected in patients with heart failure with reduced ejection fraction (HFrEF). Sodium-glucose co-transporter-2 (SGLT2) inhibitor therapy positively affects LV functions as well as having functional and symptomatic benefits in HFrEF patients. In this study, we aimed to evaluate the effects of SGLT2 inhibitor treatment on RV function and PAS in HFrEF patients. Materials andMethods: 168 HFrEF patients with New York Heart Association (NYHA) class ≥2 symptoms despite optimal medical treatment and who were started on SGLT2 inhibitor therapy were included in this retrospective study. NYHA classification, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, Minnesota Living with Heart Failure Questionnaire (MLWHFQ) scores, laboratory tests, and transthoracic echocardiography (TTE) measurements were recorded before treatment and at the end of the 6-month follow-up. Results: The mean age of the patients was 62.7 ± 11.4 years, and 38 (22.6%) were women. RV function (RV fractional area change (FAC) (33.8 ± 6.4% vs. 39.2 ± 7.3%, p < 0.001); tricuspid annular plane systolic excursion (TAPSE) (18.4 ± 3.8 mm vs. 19.6 ± 3.6 mm, p < 0.001); RV S’ (10 (8 − 13) cm/s vs. 13 (10 − 16) cm/s, p < 0.001); RV myocardial performance index (RV MPI) (0.68 ± 0.12 vs. 0.59 ± 0.11, p < 0.001); mean pulmonary artery pressure (mPAP) (39.6 ± 7.8 mmHg vs. 32 ± 6.8 mmHg, p = 0.003)) and PAS (24.2 ± 4.6 kHz/ms vs. 18.6 ± 3.1 kHz/ms, p < 0.001) values at the 6-month follow-up after SGLT2 inhibitor therapy significantly improved. It was found that SGLT2 inhibitor treatment provided significant improvement in NYHA classification, MLWHFQ scores, and NT-proBNP levels (2876 ± 401 vs. 1034 ± 361, p < 0.001), and these functional and symptomatic positive changes in HFrEF patients were significantly correlated with positive changes in LVEF, PAS, and RV functional status. Conclusions: SGLT2 inhibitor treatment results in symptomatic and functional well-being in HFrEF patients, as well as positive changes in RV function and PAS.
在射血分数降低的心力衰竭（HFrEF）患者中，除了左心室（LV）功能外，右心室（RV）功能和肺动脉僵硬度（PAS）也可能受到不利影响。钠-葡萄糖共转运蛋白-2（SGLT2）抑制剂治疗对 LV 功能具有积极影响，并且对 HFrEF 患者具有功能和症状益处。在这项研究中，我们旨在评估 SGLT2 抑制剂治疗对 HFrEF 患者 RV 功能和 PAS 的影响。
这项回顾性研究纳入了 168 名因最佳药物治疗后仍出现纽约心脏协会（NYHA）≥2 级症状而开始接受 SGLT2 抑制剂治疗的 HFrEF 患者。记录 NYHA 分级、N 末端脑利钠肽前体（NT-proBNP）水平、明尼苏达州心力衰竭生活质量问卷（MLWHFQ）评分、实验室检查和经胸超声心动图（TTE）测量值，分别在治疗前和 6 个月随访结束时。
患者的平均年龄为 62.7 ± 11.4 岁，38 名（22.6%）为女性。RV 功能（RV 分数面积变化（FAC）（33.8 ± 6.4%比 39.2 ± 7.3%，p < 0.001）；三尖瓣环平面收缩期位移（TAPSE）（18.4 ± 3.8 mm 比 19.6 ± 3.6 mm，p < 0.001）；RV S’（10（8-13）cm/s 比 13（10-16）cm/s，p < 0.001）；RV 心肌做功指数（RV MPI）（0.68 ± 0.12 比 0.59 ± 0.11，p < 0.001）；平均肺动脉压（mPAP）（39.6 ± 7.8 mmHg 比 32 ± 6.8 mmHg，p = 0.003））和 PAS（24.2 ± 4.6 kHz/ms 比 18.6 ± 3.1 kHz/ms，p < 0.001）值在 SGLT2 抑制剂治疗 6 个月后随访时显著改善。发现 SGLT2 抑制剂治疗可显著改善 NYHA 分级、MLWHFQ 评分和 NT-proBNP 水平（2876 ± 401 比 1034 ± 361，p < 0.001），并且 HFrEF 患者的这些功能和症状的阳性变化与 LVEF、PAS 和 RV 功能状态的阳性变化显著相关。
SGLT2 抑制剂治疗可改善 HFrEF 患者的症状和功能，并改善 RV 功能和 PAS。
