SGLT2 inhibitors and cardiovascular outcomes in patients with left ventricular assist devices.

Abstract

Introduction: Left ventricular assist devices (LVADs) provide critical support for patients with advanced heart failure (HF), but complications and suboptimal outcomes remain challenges. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown promise in HF, but their role in patients with LVADs is not well established. We aimed to evaluate the association of SGLT2 inhibitors with clinical outcomes and heart transplantation rates in patients with LVADs.

Methods: We conducted a retrospective cohort study using the TriNetX Network (2014-2022) to identify all adults (≥18 years old) with LVADs. Patients were stratified into SGLT2 inhibitor users and non-users during LVAD-supported period. Propensity score matching (1:1, PSM) was performed to balance baseline characteristics between two cohorts. Efficacy outcomes included all-cause mortality/hospitalization, HF exacerbations, acute myocardial infarction, cerebral infarction, cardiac arrest, and heart transplant. Safety outcomes included acute kidney injury (AKI), urinary tract infection (UTI), and urogenital candidiasis. Adjusted odds ratios (aORs) with 95 % confidence intervals (CIs) were calculated.

Results: Among 3736 patients with LVADs, 1106 received SGLT2 inhibitors from 2014 to 2022. After PSM, 656 patients were included in each group. SGLT2 inhibitor use was associated with lower risks of all-cause mortality [0.571 (95 % CI, 0.430-0.759)], all-cause hospitalization [aOR 0.619 (0.478-0.802)], acute HF exacerbations [aOR 0.687 (0.539-0.877)], cerebral infarction [aOR 0.676 (0.501-0.912)], and cardiac arrest [aOR 0.441 (0.269-0.725)]. No significant differences were observed for heart transplantation rates [aOR 1.084 (0.834-1.408)] or acute MI [aOR 0.881 (0.663-1.172)]. Safety outcomes favored SGLT2 inhibitor cohort with lower risks of AKI [aOR 0.767 (0.617-0.954)], with no significant difference for UTI [aOR 0.730 (0.527-1.012)] or urogenital candidiasis [aOR 1.000 (0.413-2.419)].

Conclusions: SGLT2 inhibitor use in LVAD-supported patients was associated with improved survival, reduced hospitalizations and heart failure exacerbation alongside favorable safety outcomes. These findings support further investigation into SGLT2 inhibitors as a potential adjunctive therapy in the management of patients with LVADs.