Clinical Effects of Sodium-Glucose Cotransporter 2 Inhibitors on Children with Single Ventricle Congenital Heart Disease: A Single-Center Experience.

Abstract

This study evaluates the impact of sodium-glucose cotransporter 2 inhibitors (SGLT2i) on pediatric patients with single ventricle (SV) heart disease, using invasive and non-invasive markers of cardiac function. We reviewed patients (< 21 years) with SV physiology who received ≥ 90 days SGLT2i at our center from 2020 to 2025. Baseline laboratory, echocardiographic, and hemodynamic data were recorded and compared to follow up data after ≥ 90 days on SGLT2i. Hospitalizations before and after SGLT2i were also analyzed. Seventy-seven patients with median age 10.5 years (range 47 days-19.9 years) had median treatment duration of 386 days (IQR 218-853). Among 62 patients (81%) with echocardiographic data (Fontan [39], Glenn [18], Stage 1 [5]) there was a significant decrease in median qualitative AVVR score from mild-moderate to mild (p = 0.01). Median BNP decreased from 84 pg/mL (IQR 18-274) to 42 pg/mL (IQR 18-105) (p = 0.02) and mean hemoglobin increased from 14.4 ± 2.5 g/dL to 15.5 ± 2.4 g/dL (p < 0.01). Ten patients had hemodynamic data without significant change in mean pulmonary artery pressure from 17 to 16 mmHg (p = 0.168) or ventricular end-diastolic pressure from 10 to 11 mmHg (p = 0.275). More patients had > 1 hospitalizations for heart failure during the 6-months prior to SGLT2i compared to the 6-months following initiation, with an odds ratio of 4.5 (95% CI: 1.6-13.7, p < 0.01). Overall, we identified significant reductions in AVVR, BNP, and hospitalizations for heart failure after ≥ 90 days of therapy. Further larger scale studies are needed to determine if SGLT2i will affect clinical outcomes in the pediatric SV population.