Impact of Combined Treatment with ARNi and SGLT2i on Clinical and Echocardiographic Outcomes in Patients with CRT During Mid-Term Period.

Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) and angiotensin receptor neprilysin inhibitors (ARNi) are new classes of medications with an evolving role in heart failure (HF) patients. However, the effect of combining these drugs with cardiac resynchronization therapy (CRT) remains less certain.

Objective: This study aimed to investigate the impact of combined treatment with ARNi and SGLT2i on clinical and echocardiographic outcomes in CRT patients during 12-month followup.

Methods: HF patients with CRT implantation indications were enrolled in the non-randomized and retrospective study and were grouped in no ARNi and SGLT2i (1st group) and combined treatment with ARNi and SGLT2i (2nd group) cohorts. The CRT response criteria were as follows: improvement of NYHA class ≥1 and left ventricular end-systolic volume reduction ≥15% or left ventricular ejection fraction improvement ≥5% from the baseline during the 12-month follow- up.

Results: A total of 52 patients were included. At the 12-month follow-up, 18 of 35 (51.4%) patients in the 1st group and 16 of 17 patients (94.1%) in the 2nd cohort met CRT responder criteria (p=0.002). In multivariable logistic regression, combined treatment with ARNi and SGLT2i [odds ratio (OR): 20.09; 95% confidence interval (CI): 2.10-192.15; p=0.009] and non-ischemic HF (OR 5.51; 95% CI 1.21-24.91; p=0.026) were associated with CRT response.

Conclusion: The combined treatment with SGLT2i and ARNi in patients with CRT improved the echocardiographic and clinical outcomes during the 12-month follow-up. In our study cohort, the CRT response was associated with non-ischemic HF and combined treatment with ARNi and SGLT2i.