Effects of Sglt-2 Inhibitor Use among LVAD Patients

Introduction SGLT-2 inhibitors are known to reduce morbidity and mortality in HFrEF (Heart failure with reduced ejection fraction) patients. There is lack of studies assessing outcomes of SGLT-2 inhibitors in LVAD subpopulation of HFrEF patients. Methods We conducted a retrospective analysis of LVAD patients. We used paired student's t-test for statistical analysis to assess changes in Kansas City Cardiomyopathy Questionnaire Score (KCCQ), EF (Ejection fraction), HbA1c, ProBNP, and eGFR (Estimated glomerular filtration rate) over a 1-year follow up period. Results A total of 77 LVAD patients were identified from November 2018 to April 2022, of whom 20 (26%) were treated with SGLT2i. The majority were on dapagliflozin (12), with 6 on empagliflozin, and 1 on canagliflozin, and 1 on ertugliflozin. Most patients were on SGLT-2 inhibitor before LVAD insertion, with only 2 who were started during the same admission, and 3 who were started after LVAD. The majority of patients were males, and all were implanted with HeartMate3 LVAD. Baseline characteristics are shown in Table 1. There was a statistically significant increase in Kansas City Cardiomyopathy Questionnaire Score (KCCQ) from baseline to 1-year among LVAD patients on SGLT2i (11.5±10.1, p=0.04). There was a trend towards increased EF but did not reach statistical significance (Table 2). Non-SGLT2i patients also had increased KCCQ (11.3±13.6, P=0.003). Among SGLT2i patients, the all-cause rehospitalization rate at 1 year was 55%. No patients died during the 1 year follow up. 3 patients had hypoglycemia. There were no documented cases of urinary tract infections, genital infections or diabetic ketoacidosis over the 1-year follow up period. Conclusion SGL2ti appears to be used safely in our LVAD population. There is a need for larger prospective studies to evaluate the safety and outcomes of SGLT2i in LVAD patients.