Pillai Ashwin, Riaz Sana, Arora Sabeena, Jaiswal Abhishek
Medicine, University of Connecticut Health, Farmington, USA.
Cardiology, Texas Heart Institute at Baylor St. Luke's Medical Center, Houston, USA.
Cureus. 2024 Oct 30;16(10):e72725. doi: 10.7759/cureus.72725. eCollection 2024 Oct.
Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy with limited treatment options. Barring mineralocorticoid receptor antagonists, most classes of guideline-directed medical therapy including renin-angiotensin-aldosterone inhibitors and beta blockers are avoided in CA due to intolerance and the risk of potentiating orthostatic hypotension. Few studies have explored the safety and utility of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in CA. These agents have demonstrated benefit in most heart failure phenotypes, and individuals with CA may benefit from treatment with them. We report a single-center experience demonstrating the safety of SGLT2is in patients with cardiac amyloidosis.
We conducted a retrospective study including patients with CA from January 2020 to March 2023 who were treated with empagliflozin at doses of 10 mg or 25 mg daily or dapagliflozin at a dose of 10 mg daily. Patients were monitored clinically for the development of adverse effects including urinary tract infections and orthostatic hypotension as well as through laboratory monitoring for acute kidney injury and for changes in microalbuminuria.
Our cohort comprised 53 patients with cardiac amyloidosis treated with an SGLT2i, 38 (72%) of whom were male, with a mean participant age of 81±8 years and left ventricular ejection fraction of 50%. Urinary tract infections were observed in three participants (6%). Acute kidney injury occurred in two participants. No participant experienced orthostatic hypotension. There was a trend toward improved functional status, reduced hospitalizations (decrease from median 1 to 0.6 per patient-year, p=0.18), and microalbuminuria (mean albumin:creatinine ratio of 53.8 mg/g improved to 29.2 mg/g, p=0.32), although these differences were not statistically significant.
Within our cohort of individuals with cardiac amyloidosis, SGLT2i therapy appeared to be well-tolerated and may have clinical benefit in the form of reduced hospitalizations and improvements in microalbuminuria. Notably, the differences in outcomes were not statistically significant. By demonstrating safety and tolerance, we hope to stimulate prospective randomized studies that may definitively explore the utility of SGLT2i therapy in enhancing clinical outcomes.
心脏淀粉样变性（CA）是一种浸润性心肌病，治疗选择有限。除盐皮质激素受体拮抗剂外，由于不耐受以及有加重体位性低血压的风险，在CA中应避免使用包括肾素-血管紧张素-醛固酮抑制剂和β受体阻滞剂在内的大多数指南指导的药物治疗。很少有研究探讨钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）在CA中的安全性和实用性。这些药物在大多数心力衰竭表型中已显示出益处，CA患者可能从使用它们的治疗中获益。我们报告了一项单中心经验，证明了SGLT2i在心脏淀粉样变性患者中的安全性。
我们进行了一项回顾性研究，纳入了2020年1月至2023年3月期间接受恩格列净每日10毫克或25毫克剂量或达格列净每日10毫克剂量治疗的CA患者。对患者进行临床监测，观察包括尿路感染和体位性低血压在内的不良反应的发生情况，并通过实验室监测观察急性肾损伤和微量白蛋白尿的变化。
我们的队列包括53例接受SGLT2i治疗的心脏淀粉样变性患者，其中38例（72%）为男性，参与者的平均年龄为81±8岁，左心室射血分数为50%。3名参与者（6%）出现尿路感染。2名参与者发生急性肾损伤。没有参与者出现体位性低血压。尽管这些差异无统计学意义，但在功能状态改善、住院次数减少（从每位患者每年中位数1次降至0.6次，p=0.18）和微量白蛋白尿方面有改善趋势（平均白蛋白：肌酐比值从53.8毫克/克改善至29.2毫克/克，p=0.32）。
在我们的心脏淀粉样变性患者队列中，SGLT2i治疗似乎耐受性良好，可能在减少住院次数和改善微量白蛋白尿方面具有临床益处。值得注意的是，结果差异无统计学意义。通过证明安全性和耐受性，我们希望激发前瞻性随机研究，以明确探索SGLT2i治疗在改善临床结局方面的效用。
