钠-葡萄糖协同转运蛋白 2 抑制剂治疗射血分数降低的心力衰竭患者。

SGLT2 inhibitor therapy in patients with advanced heart failure and reduced ejection fraction.

机构信息

Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy.

出版信息

Curr Probl Cardiol. 2024 Nov;49(11):102823. doi: 10.1016/j.cpcardiol.2024.102823. Epub 2024 Aug 28.

DOI:10.1016/j.cpcardiol.2024.102823

PMID:39208997

Abstract

AIMS

Sodium-glucose cotransporter inhibitors (SGLT2-i) improve outcomes in patients with heart failure (HF) and reduced ejection fraction (HFrEF). However, evidence in patients with advanced HF is lacking. We aimed to determine the effect of SGLT2-i in advanced HFrEF compared to their effect on a non-advanced population.

METHODS

Consecutive HFrEF outpatients who started SGLT2-i were observed for 6-months. Patients were categorized as having advanced or non-advanced HFrEF. The primary outcome was the trend of NTproBNP in the two groups. Secondary outcomes included changes in New York Heart Association (NYHA) class, glomerular filtration rate (GFR), and ejection fraction (LVEF). The association between advanced HF diagnosis and including N-terminal pro-brain natriuretic peptide (NTproBNP) reduction was tested using multivariate analysis.

RESULTS

Overall, 105 patients (45 advanced, 60 non-advanced) were included. Mean age was 56 ± 10 years, 22 % were female, and 35 % had ischemic heart disease. Median NTproBNP at baseline for advanced and non-advanced patients was 1672pg/ml (IQR 520-3320) vs. 481 pg/ml (IQR 173-917), respectively (p < 0.001). At follow-up, only non-advanced patients reduced their NTproBNP (-32 % (95 % CI -51 to -3), p < 0.001), while advanced patients had an increase in NTproBNP. LVEF and NYHA class improved only in non-advanced patients. GFR was stable in both subgroups. At multivariate analysis a diagnosis of advanced HF was independently associated with a reduced probability of NTproBNP reduction (OR 0.041 (95 % CI 0.002-0.752), p = 0.031). Only one patient discontinued the drug due to side effects.

CONCLUSION

In advanced HFrEF, SGLT2-i do not impact on NTproBNP, LVEF or NYHA class but are well tolerated.

摘要

目的

钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2-i）可改善射血分数降低的心力衰竭（HFrEF）患者的预后。然而，在心力衰竭晚期患者中的证据尚缺乏。本研究旨在比较 SGLT2-i 在心力衰竭晚期患者中的作用与在非晚期患者中的作用。

方法

连续观察开始 SGLT2-i 治疗的 HFrEF 门诊患者 6 个月。将患者分为心力衰竭晚期和非晚期。主要结局为两组患者 N 末端脑钠肽前体（NTproBNP）的变化趋势。次要结局包括纽约心脏协会（NYHA）心功能分级、肾小球滤过率（GFR）和射血分数（LVEF）的变化。采用多变量分析检验晚期心力衰竭诊断与包括 N 末端脑钠肽前体（NTproBNP）降低之间的关系。

结果

共纳入 105 例患者（45 例心力衰竭晚期，60 例非晚期）。平均年龄为 56±10 岁，22%为女性，35%为缺血性心脏病患者。心力衰竭晚期和非晚期患者的基线 NTproBNP 中位数分别为 1672pg/ml（IQR 520-3320）和 481pg/ml（IQR 173-917）（p<0.001）。随访时，仅非晚期患者的 NTproBNP 降低（-32%（95%CI-51 至-3），p<0.001），而心力衰竭晚期患者的 NTproBNP 升高。仅非晚期患者的 LVEF 和 NYHA 心功能分级改善。两组的 GFR 均保持稳定。多变量分析显示，晚期心力衰竭诊断与 NTproBNP 降低的可能性降低独立相关（OR 0.041（95%CI 0.002-0.752），p=0.031）。仅 1 例患者因不良反应停药。