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
{"title":"SGLT2抑制剂在接受经导管主动脉瓣植入术（TAVI）的患有严重主动脉瓣狭窄和心脏损伤的糖尿病患者中的应用。","authors":"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","doi":"10.1186/s12933-024-02504-8","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":9374,"journal":{"name":"Cardiovascular Diabetology","volume":"23 1","pages":"420"},"PeriodicalIF":8.5000,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583434/pdf/","citationCount":"0","resultStr":"{\"title\":\"SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI).\",\"authors\":\"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\",\"doi\":\"10.1186/s12933-024-02504-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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).</p><p><strong>Conclusions: </strong>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.</p>\",\"PeriodicalId\":9374,\"journal\":{\"name\":\"Cardiovascular Diabetology\",\"volume\":\"23 1\",\"pages\":\"420\"},\"PeriodicalIF\":8.5000,\"publicationDate\":\"2024-11-21\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583434/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiovascular Diabetology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s12933-024-02504-8\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiovascular Diabetology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s12933-024-02504-8","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
SGLT2-inhibitors in diabetic patients with severe aortic stenosis and cardiac damage undergoing transcatheter aortic valve implantation (TAVI).
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.
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Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.
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