SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI)
Abstract Background 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 w...
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BMC
2024-11-01
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| Series: | Cardiovascular Diabetology |
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| Online Access: | https://doi.org/10.1186/s12933-024-02504-8 |
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| author | Pasquale Paolisso Marta Belmonte Emanuele Gallinoro Roberto Scarsini Luca Bergamaschi Leonardo Portolan Matteo Armillotta Giuseppe Esposito Elisabetta Moscarella Giovanni Benfari Claudio Montalto Monika Shumkova Elayne Kelen de Oliveira Francesco Angeli Mateusz Orzalkiewicz Margherita Fabroni Nurcan Baydaroglu Andrea Raffaele Munafò Daniele Oreste D’Atri Matteo Casenghi Lucia Scisciola Michelangela Barbieri Raffaele Marfella Felice Gragnano Edoardo Conte Dario Pellegrini Alfonso Ielasi Daniele Andreini Martin Penicka Jacopo Andrea Oreglia Paolo Calabrò Antonio Bartorelli Carmine Pizzi Tullio Palmerini Marc Vanderheyden Francesco Saia Flavio Ribichini Emanuele Barbato |
| author_facet | Pasquale Paolisso Marta Belmonte Emanuele Gallinoro Roberto Scarsini Luca Bergamaschi Leonardo Portolan Matteo Armillotta Giuseppe Esposito Elisabetta Moscarella Giovanni Benfari Claudio Montalto Monika Shumkova Elayne Kelen de Oliveira Francesco Angeli Mateusz Orzalkiewicz Margherita Fabroni Nurcan Baydaroglu Andrea Raffaele Munafò Daniele Oreste D’Atri Matteo Casenghi Lucia Scisciola Michelangela Barbieri Raffaele Marfella Felice Gragnano Edoardo Conte Dario Pellegrini Alfonso Ielasi Daniele Andreini Martin Penicka Jacopo Andrea Oreglia Paolo Calabrò Antonio Bartorelli Carmine Pizzi Tullio Palmerini Marc Vanderheyden Francesco Saia Flavio Ribichini Emanuele Barbato |
| author_sort | Pasquale Paolisso |
| collection | DOAJ |
| description | Abstract Background 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). Methods 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. Results 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). Conclusions 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. Graphical Abstract |
| format | Article |
| id | doaj-art-1fc8effcb9c243e19a4efdcc3a908deb |
| institution | Kabale University |
| issn | 1475-2840 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | Cardiovascular Diabetology |
| spelling | doaj-art-1fc8effcb9c243e19a4efdcc3a908deb2025-01-19T12:09:03ZengBMCCardiovascular Diabetology1475-28402024-11-0123111210.1186/s12933-024-02504-8SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI)Pasquale Paolisso0Marta Belmonte1Emanuele Gallinoro2Roberto Scarsini3Luca Bergamaschi4Leonardo Portolan5Matteo Armillotta6Giuseppe Esposito7Elisabetta Moscarella8Giovanni Benfari9Claudio Montalto10Monika Shumkova11Elayne Kelen de Oliveira12Francesco Angeli13Mateusz Orzalkiewicz14Margherita Fabroni15Nurcan Baydaroglu16Andrea Raffaele Munafò17Daniele Oreste D’Atri18Matteo Casenghi19Lucia Scisciola20Michelangela Barbieri21Raffaele Marfella22Felice Gragnano23Edoardo Conte24Dario Pellegrini25Alfonso Ielasi26Daniele Andreini27Martin Penicka28Jacopo Andrea Oreglia29Paolo Calabrò30Antonio Bartorelli31Carmine Pizzi32Tullio Palmerini33Marc Vanderheyden34Francesco Saia35Flavio Ribichini36Emanuele Barbato37Clinical Cardiology and Cardiovascular Imaging Unit, IRCCS Galeazzi-Sant’Ambrogio HospitalCardiovascular Center Aalst, OLV-ClinicClinical Cardiology and Cardiovascular Imaging Unit, IRCCS Galeazzi-Sant’Ambrogio HospitalCardiovascular Department, Azienda Ospedaliero Universitaria Integrata di VeronaUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), Sant’Orsola-Malpighi Hospital, IRCCS, University of BolognaCardiovascular Department, Azienda Ospedaliero Universitaria Integrata di VeronaUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), Sant’Orsola-Malpighi Hospital, IRCCS, University of BolognaInterventional Cardiology Unit, De Gasperis Cardio Center, Niguarda HospitalDivision of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”Cardiovascular Department, Azienda Ospedaliero Universitaria Integrata di VeronaInterventional Cardiology Unit, De Gasperis Cardio Center, Niguarda HospitalCardiovascular Center Aalst, OLV-ClinicCardiovascular Center Aalst, OLV-ClinicUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), Sant’Orsola-Malpighi Hospital, IRCCS, University of BolognaUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), Sant’Orsola-Malpighi Hospital, IRCCS, University of BolognaCardiovascular Department, Azienda Ospedaliero Universitaria Integrata di VeronaInterventional Cardiology Unit, De Gasperis Cardio Center, Niguarda HospitalInterventional Cardiology Unit, De Gasperis Cardio Center, Niguarda HospitalCardiology Division, IRCCS Galeazzi-Sant’Ambrogio HospitalDivision of Cardiology, Sant’Andrea HospitalDepartment of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”Department of Advanced Medical and Surgical Sciences, University of Campania “Luigi Vanvitelli”Division of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”Clinical Cardiology and Cardiovascular Imaging Unit, IRCCS Galeazzi-Sant’Ambrogio HospitalCardiology Division, IRCCS Galeazzi-Sant’Ambrogio HospitalCardiology Division, IRCCS Galeazzi-Sant’Ambrogio HospitalClinical Cardiology and Cardiovascular Imaging Unit, IRCCS Galeazzi-Sant’Ambrogio HospitalCardiovascular Center Aalst, OLV-ClinicInterventional Cardiology Unit, De Gasperis Cardio Center, Niguarda HospitalDivision of Cardiology, A.O.R.N. “Sant’Anna e San Sebastiano”Clinical Cardiology and Cardiovascular Imaging Unit, IRCCS Galeazzi-Sant’Ambrogio HospitalUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), Sant’Orsola-Malpighi Hospital, IRCCS, University of BolognaUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), Sant’Orsola-Malpighi Hospital, IRCCS, University of BolognaCardiovascular Center Aalst, OLV-ClinicUnit of Cardiology, Department of Medical and Surgical Sciences (DIMEC), Sant’Orsola-Malpighi Hospital, IRCCS, University of BolognaCardiovascular Department, Azienda Ospedaliero Universitaria Integrata di VeronaDivision of Cardiology, Sant’Andrea HospitalAbstract Background 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). Methods 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. Results 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). Conclusions 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. Graphical Abstracthttps://doi.org/10.1186/s12933-024-02504-8Aortic stenosisTAVISGLT2iCardiac damage stagingLow-flow low-gradientCardiac remodeling |
| spellingShingle | Pasquale Paolisso Marta Belmonte Emanuele Gallinoro Roberto Scarsini Luca Bergamaschi Leonardo Portolan Matteo Armillotta Giuseppe Esposito Elisabetta Moscarella Giovanni Benfari Claudio Montalto Monika Shumkova Elayne Kelen de Oliveira Francesco Angeli Mateusz Orzalkiewicz Margherita Fabroni Nurcan Baydaroglu Andrea Raffaele Munafò Daniele Oreste D’Atri Matteo Casenghi Lucia Scisciola Michelangela Barbieri Raffaele Marfella Felice Gragnano Edoardo Conte Dario Pellegrini Alfonso Ielasi Daniele Andreini Martin Penicka Jacopo Andrea Oreglia Paolo Calabrò Antonio Bartorelli Carmine Pizzi Tullio Palmerini Marc Vanderheyden Francesco Saia Flavio Ribichini Emanuele Barbato SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI) Cardiovascular Diabetology Aortic stenosis TAVI SGLT2i Cardiac damage staging Low-flow low-gradient Cardiac remodeling |
| title | SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI) |
| title_full | SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI) |
| title_fullStr | SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI) |
| title_full_unstemmed | SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI) |
| title_short | SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI) |
| title_sort | sglt2 inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation tavi |
| topic | Aortic stenosis TAVI SGLT2i Cardiac damage staging Low-flow low-gradient Cardiac remodeling |
| url | https://doi.org/10.1186/s12933-024-02504-8 |
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