Potential Hematopoietic Effects of SGLT2 Inhibitors in Patients with Cardiac Amyloidosis

Background: Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have been found to have potential hematopoietic effects in patients with heart failure (HF). However, these benefits have not been studied in patients with cardiac amyloidosis (CA). CA patients present with HF symptoms...

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Main Authors: Nikita Ermolaev, Robin Willixhofer, Christoph Krall, Christina Kronberger, René Rettl, Christina Binder, Franz Duca, Christian Nitsche, Andreas Kammerlander, Michael Poledniczek, Bernhard Gregshammer, Diana Ahmadi-Fazel, Mahshid Eslami, Luciana Camuz Ligios, Johannes Kastner, Jutta Bergler-Klein, Roza Badr Eslam
Format: Article
Language:English
Published: IMR Press 2025-03-01
Series:Reviews in Cardiovascular Medicine
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Online Access:https://www.imrpress.com/journal/RCM/26/3/10.31083/RCM26081
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author Nikita Ermolaev
Robin Willixhofer
Christoph Krall
Christina Kronberger
René Rettl
Christina Binder
Franz Duca
Christian Nitsche
Andreas Kammerlander
Michael Poledniczek
Bernhard Gregshammer
Diana Ahmadi-Fazel
Mahshid Eslami
Luciana Camuz Ligios
Johannes Kastner
Jutta Bergler-Klein
Roza Badr Eslam
author_facet Nikita Ermolaev
Robin Willixhofer
Christoph Krall
Christina Kronberger
René Rettl
Christina Binder
Franz Duca
Christian Nitsche
Andreas Kammerlander
Michael Poledniczek
Bernhard Gregshammer
Diana Ahmadi-Fazel
Mahshid Eslami
Luciana Camuz Ligios
Johannes Kastner
Jutta Bergler-Klein
Roza Badr Eslam
author_sort Nikita Ermolaev
collection DOAJ
description Background: Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have been found to have potential hematopoietic effects in patients with heart failure (HF). However, these benefits have not been studied in patients with cardiac amyloidosis (CA). CA patients present with HF symptoms and often suffer from iron deficiency, which has a negative impact on erythropoiesis and leads to lower hemoglobin and hematocrit levels. We sought to determine the potential effects of SGLT2i on hematological parameters and functional capacity (FC) in CA patients. Methods: A prospective analysis was conducted to compare the effects of SGLT2i in patients who received the best medical therapy (BMT) along with SGLT2i (n = 20), versus patients receiving only BMT without SGLT2i (n = 20) (historical control group). All patients underwent blood testing and cardiopulmonary exercise testing (CPET) at baseline (BL) and after 6 months [interquartile range (IQR): 4.0 to 8.0]. Results: The SGLT2i-based therapy resulted in a significant improvement and difference in hematological parameters at 6 months follow-up compared to the control group. In the SGLT2i group, the mean hemoglobin level increased (+1.2 mg/dL), whereas in the control group, it decreased (–0.8 g/dL) (p < 0.001 for overall group comparison). The hematocrit showed a significant increase in the SGLT2i group (+4.4%) compared to a decrease in the control group (–1.8%) (p < 0.001). Additionally, the serum iron level improved in the SGLT2i-treated group (+ 5.5 [–5.0 to 17.5] μg/dL vs. –6.0 [–15.0 to 4.0] μg/dL, p = 0.121). Although there was no significant change in the peak oxygen consumption (peak VO2, (mL/min)/kg) (p = 0.206), as well as in pulmonary ventilation (VE)/carbon dioxide production (VCO2) slope in both groups (p = 0.964), the SGLT2i group maintained a peak VO2 and VE/VCO2 slope throughout the study. Conclusions: SGLT2i therapy improved hematological parameters and stabilized the FC of CA patients.
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series Reviews in Cardiovascular Medicine
spelling doaj-art-18cdf8396c4d4fcaa0e46a01ea2fc32d2025-08-20T02:48:16ZengIMR PressReviews in Cardiovascular Medicine1530-65502025-03-012632608110.31083/RCM26081S1530-6550(24)01711-3Potential Hematopoietic Effects of SGLT2 Inhibitors in Patients with Cardiac AmyloidosisNikita Ermolaev0Robin Willixhofer1Christoph Krall2Christina Kronberger3René Rettl4Christina Binder5Franz Duca6Christian Nitsche7Andreas Kammerlander8Michael Poledniczek9Bernhard Gregshammer10Diana Ahmadi-Fazel11Mahshid Eslami12Luciana Camuz Ligios13Johannes Kastner14Jutta Bergler-Klein15Roza Badr Eslam16Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaCenter for Medical Data Science, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaDivision of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, AustriaBackground: Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have been found to have potential hematopoietic effects in patients with heart failure (HF). However, these benefits have not been studied in patients with cardiac amyloidosis (CA). CA patients present with HF symptoms and often suffer from iron deficiency, which has a negative impact on erythropoiesis and leads to lower hemoglobin and hematocrit levels. We sought to determine the potential effects of SGLT2i on hematological parameters and functional capacity (FC) in CA patients. Methods: A prospective analysis was conducted to compare the effects of SGLT2i in patients who received the best medical therapy (BMT) along with SGLT2i (n = 20), versus patients receiving only BMT without SGLT2i (n = 20) (historical control group). All patients underwent blood testing and cardiopulmonary exercise testing (CPET) at baseline (BL) and after 6 months [interquartile range (IQR): 4.0 to 8.0]. Results: The SGLT2i-based therapy resulted in a significant improvement and difference in hematological parameters at 6 months follow-up compared to the control group. In the SGLT2i group, the mean hemoglobin level increased (+1.2 mg/dL), whereas in the control group, it decreased (–0.8 g/dL) (p < 0.001 for overall group comparison). The hematocrit showed a significant increase in the SGLT2i group (+4.4%) compared to a decrease in the control group (–1.8%) (p < 0.001). Additionally, the serum iron level improved in the SGLT2i-treated group (+ 5.5 [–5.0 to 17.5] μg/dL vs. –6.0 [–15.0 to 4.0] μg/dL, p = 0.121). Although there was no significant change in the peak oxygen consumption (peak VO2, (mL/min)/kg) (p = 0.206), as well as in pulmonary ventilation (VE)/carbon dioxide production (VCO2) slope in both groups (p = 0.964), the SGLT2i group maintained a peak VO2 and VE/VCO2 slope throughout the study. Conclusions: SGLT2i therapy improved hematological parameters and stabilized the FC of CA patients.https://www.imrpress.com/journal/RCM/26/3/10.31083/RCM26081amyloid cardiomyopathyheart failuresodium-glucose cotransporter 2 inhibitorshematopoiesisfunctional capacitycardiopulmonary exercise testing
spellingShingle Nikita Ermolaev
Robin Willixhofer
Christoph Krall
Christina Kronberger
René Rettl
Christina Binder
Franz Duca
Christian Nitsche
Andreas Kammerlander
Michael Poledniczek
Bernhard Gregshammer
Diana Ahmadi-Fazel
Mahshid Eslami
Luciana Camuz Ligios
Johannes Kastner
Jutta Bergler-Klein
Roza Badr Eslam
Potential Hematopoietic Effects of SGLT2 Inhibitors in Patients with Cardiac Amyloidosis
Reviews in Cardiovascular Medicine
amyloid cardiomyopathy
heart failure
sodium-glucose cotransporter 2 inhibitors
hematopoiesis
functional capacity
cardiopulmonary exercise testing
title Potential Hematopoietic Effects of SGLT2 Inhibitors in Patients with Cardiac Amyloidosis
title_full Potential Hematopoietic Effects of SGLT2 Inhibitors in Patients with Cardiac Amyloidosis
title_fullStr Potential Hematopoietic Effects of SGLT2 Inhibitors in Patients with Cardiac Amyloidosis
title_full_unstemmed Potential Hematopoietic Effects of SGLT2 Inhibitors in Patients with Cardiac Amyloidosis
title_short Potential Hematopoietic Effects of SGLT2 Inhibitors in Patients with Cardiac Amyloidosis
title_sort potential hematopoietic effects of sglt2 inhibitors in patients with cardiac amyloidosis
topic amyloid cardiomyopathy
heart failure
sodium-glucose cotransporter 2 inhibitors
hematopoiesis
functional capacity
cardiopulmonary exercise testing
url https://www.imrpress.com/journal/RCM/26/3/10.31083/RCM26081
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