Clinical Cardiology and Cardiovascular Imaging Unit, IRCCS Galeazzi-Sant'Ambrogio Hospital, Milan, Italy.
Cardiovascular Center Aalst, OLV-Clinic, Aalst, Belgium.
Cardiovasc Diabetol. 2024 Nov 21;23(1):420. doi: 10.1186/s12933-024-02504-8.
A substantial number of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) experience adverse events after TAVI, with health care expenditure. We aimed to investigate cardiac remodeling and long-term outcomes in diabetic patients with severe AS, left ventricular ejection fraction (LVEF) < 50%, and extra-valvular cardiac damage (EVCD) undergoing TAVI treated with sodium-glucose cotransporter-2 inhibitors (SGLT2i) versus other glucose-lowering strategies (no-SGLT2i users).
Multicenter international registry of consecutive diabetic patients with severe AS, LVEF < 50%, and EVCD undergoing TAVI. Based on glucose-lowering therapy at hospital discharge, patients were stratified in SGLT2i versus no-SGLT2i users. The primary endpoint was a composite of all-cause death and heart failure (HF)-hospitalization (major adverse cardiovascular events, MACE) at 2-year follow-up. Secondary outcomes included all-cause death, cardiovascular death, and HF hospitalization.
The study population included 311 patients, among which 24% were SGLT2i users. Within 1-year after TAVI, SGLT2i users experienced a higher rate of LV recovery (p = 0.032), especially those with baseline LVEF ≤ 30% (p = 0.026), despite the lower baseline LVEF. Patients not treated with SGLT2i were more likely to progress to a worse EVCD stage over time (p = 0.018). At 2-year follow-up, SGLT2i use was associated with a lower rate of MACE, all-cause death, and HF hospitalization (p < 0.01 for all). After adjusting for confounding factors, the use of SGLT2i emerged as an independent predictor of reduced MACE (HR = 0.45; 95% CI 0.17-0.75; p = 0.007), all-cause death (HR = 0.51; 95% CI 0.25-0.98; p = 0.042) and HF-hospitalization (HR = 0.40; 95% CI 0.27-0.62; p = 0.004).
In diabetic patients with severe AS, LVEF < 50%, and EVCD undergoing TAVI, the use of SGLT2i was associated with a more favorable cardiac remodeling and a reduced risk of MACE at 2-year follow-up.
大量接受经导管主动脉瓣置换术（TAVI）治疗的严重主动脉瓣狭窄（AS）患者在 TAVI 后出现不良事件，导致医疗保健支出增加。我们旨在研究患有严重 AS、左心室射血分数（LVEF）<50%和瓣周组织损害（EVCD）的糖尿病患者的心脏重构和长期预后，这些患者接受 SGLT2 抑制剂（SGLT2i）治疗与接受其他降糖策略（非 SGLT2i 使用者）的患者相比。
多中心国际注册研究连续纳入接受 TAVI 治疗的严重 AS、LVEF<50%和 EVCD 的糖尿病患者。根据出院时的降糖治疗，将患者分为 SGLT2i 和非 SGLT2i 使用者。主要终点是 2 年随访时全因死亡和心力衰竭（HF）-住院（主要不良心血管事件，MACE）的复合终点。次要结局包括全因死亡、心血管死亡和 HF 住院。
研究人群包括 311 名患者，其中 24%为 SGLT2i 使用者。在 TAVI 后 1 年内，SGLT2i 使用者的 LV 恢复率更高（p=0.032），尤其是基线 LVEF≤30%的患者（p=0.026），尽管基线 LVEF 较低。未接受 SGLT2i 治疗的患者更容易随时间进展为更严重的 EVCD 阶段（p=0.018）。在 2 年随访时，SGLT2i 治疗与较低的 MACE、全因死亡和 HF 住院率相关（所有 p<0.01）。调整混杂因素后，SGLT2i 的使用成为 MACE 降低的独立预测因素（HR=0.45；95%CI 0.17-0.75；p=0.007）、全因死亡（HR=0.51；95%CI 0.25-0.98；p=0.042）和 HF 住院（HR=0.40；95%CI 0.27-0.62；p=0.004）。
在接受 TAVI 治疗的严重 AS、LVEF<50%和 EVCD 的糖尿病患者中，SGLT2i 的使用与 2 年随访时更有利的心脏重构和降低 MACE 风险相关。
