Desai A, Sharma S, Abuah N, Jang J, Desai S, Paghdhar S, Goswami R M
Division of Advanced Heart Failure and Transplant Cardiology, Mayo Clinic, Jacksonville, FL, United States.
Front Cardiovasc Med. 2024 Jul 24;11:1376645. doi: 10.3389/fcvm.2024.1376645. eCollection 2024.
Advanced heart failure (HF) is an epidemic that affects multiple organ systems with high morbidity and mortality rates despite optimal medical therapy (OMT) and remains the leading cause of hospitalizations in type 2 diabetes-related cardiovascular disease. The addition of sodium-glucose co-transporter inhibitors (SGLT2i) in treating these patients has seen improved mortality and hospital admission rates. As such, we felt it was important to investigate whether the use of SGLT2i improved functional capacity in patients with HF when compared to OMT by evaluating maximum oxygen consumption (peak VO) using cardiopulmonary exercise testing (CPET).
We found 94 heart failure patients between August 2020 and August 2021 who underwent CPET before and after treatment at Mayo Clinic in Florida. 50 patients received OMT and 44 received OMT and SGLT2i therapy. CPET results before and after were compared for each group.
The baseline ejection fraction was not significantly different between groups, with the OMT group at 38% and the SGLT2i group at 33%, = 0.10. OMT patients were found to have a significantly lower hemoglobin A1c of 5.7 (5.4-6.1) compared to those with SGLT2i therapy of 6.4 (5.8-7.1), = 0.01. The baseline peak VO was 17.3 ml/kg/min (13.3-21.6) in the OMT group and 17.3 ml/kg/min (14.4-18.9) in the SGLT2i group, = 0.18, not significantly different. The interesting finding is that the follow-up peak VO at one year for the OMT group was 17 ml/kg/min (13.3-21.6), which was not significantly different from the SGLT2i group peak VO of 17 ml/kg/min (14.6-19.6), = 0.19. Our study is the first to compare before and after peak VO values of the OMT+SGLT2i group to the patient's own baseline and we found no significant improvement.
Our single-center data shows no improvement in functional capacity after the addition of SGLT2i therapy to OMT in patients with advanced heart failure. Improved hospitalization and symptoms may be attributed to other numerous effects of SGLT2i such as volume management.
晚期心力衰竭（HF）是一种流行病，尽管进行了最佳药物治疗（OMT），但它仍会影响多个器官系统，发病率和死亡率很高，并且仍然是2型糖尿病相关心血管疾病住院的主要原因。在治疗这些患者时添加钠-葡萄糖协同转运蛋白抑制剂（SGLT2i）可降低死亡率和住院率。因此，我们认为通过心肺运动试验（CPET）评估最大耗氧量（峰值VO₂）来研究与OMT相比，使用SGLT2i是否能改善HF患者的功能能力非常重要。
我们在2020年8月至2021年8月期间，在佛罗里达州梅奥诊所找到了94名接受治疗前后CPET检查的心力衰竭患者。50名患者接受OMT，44名患者接受OMT和SGLT2i治疗。对每组治疗前后的CPET结果进行比较。
两组之间的基线射血分数无显著差异，OMT组为38%，SGLT2i组为33%，P = 0.10。发现接受OMT治疗的患者糖化血红蛋白水平显著低于接受SGLT2i治疗的患者，分别为5.7（5.4 - 6.1）和6.4（5.8 - 7.1），P = 0.0（此处原文有误，推测为P = 0.01）。OMT组的基线峰值VO₂为17.3 ml/kg/min（13.3 - 21.6），SGLT2i组为17.3 ml/kg/min（14.4 - 18.9），P = 0.18，无显著差异。有趣的是，OMT组一年后的随访峰值VO₂为17 ml/kg/min（13.3 - 21.6），与SGLT2i组的峰值VO₂ 17 ml/kg/min（14.6 - 19.6）无显著差异，P = 0.19。我们的研究首次比较了OMT + SGLT2i组治疗前后的峰值VO₂值与患者自身基线，未发现显著改善。
我们的单中心数据表明，在晚期心力衰竭患者中，在OMT基础上加用SGLT2i治疗后，功能能力没有改善。住院率和症状的改善可能归因于SGLT2i的其他多种作用，如容量管理。
