Multiparametric evaluation of the effects of dapagliflozin in patients with heart failure and reduced ejection fraction

Background and aims: Sodium-glucose transporter 2 inhibitors have recently shown promise as a therapy to reduce mortality and hospitalisation for heart failure (HF) in patients with and without type 2 diabetes mellitus. The aim of this prospective study was to determine the results of a multiparametric evaluation after the addition of dapagliflozin to standard therapy in patients with heart failure with reduced ejection fraction (HFrEF). Methods: From February to November 2022, 45 patients with chronic HF who regularly visited our HF outpatient clinic were selected for this study. Exclusion criteria were severe chronic renal insufficiency (GFR < 25 ml/min), type 1 diabetes, hypertrophic or restrictive cardiomyopathy, active myocarditis, constrictive pericarditis. The included patients took dapagliflozin once daily in addition to sacubitril/valsartan and other HF drugs. The following parameters were recorded before the start of therapy and at the 3-month follow-up: NYHA functional class, characteristics of the cardiopulmonary exercise test (CPET), parameters of the six-minute walk test (6MWT), quality of life (QoL) using the Kansas City Cardiomyopathy Questionnaire (KCCQ), echocardiographic evaluation. Results: At 3-month follow-up, a significant increase in peak Vo2 (from 17.5 to 18.2, p < 0.001) and a significant decrease in VE/VCO2 (35.2 to 33.1, p = 0.011) were observed. In addition, Vo2/work gradient and pulse O2 increased significantly. Furthermore, a significant improvement in 6MWT, quality of life and left ventricular dimensions and systolic function was observed. Conclusion: This prospective, multiparametric study showed that the additional administration of dapaglifozin to sacubitril/valsartan and other HF drugs is effective after three months.