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ORIGINAL RESEARCH article

Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1376645

Impact of Sodium-Glucose Cotransporter-2 Inhibitor use on peak VO2 in advanced heart failure patients

Provisionally accepted
Aarti Desai Aarti Desai Shriya Sharma Shriya Sharma Nnamdi Abuah Nnamdi Abuah Ji-Min Jang Ji-Min Jang Smruti Desai Smruti Desai Smit Paghdhar Smit Paghdhar Rohan Goswami Rohan Goswami *
  • Mayo Clinic Florida, Jacksonville, United States

The final, formatted version of the article will be published soon.

    Introduction: Advanced heart failure (HF) is an epidemic that affects multiple organ systems with high morbidity and mortality rates despite optimal medical therapy (OMT) and remains the leading cause of hospitalizations in type 2 diabetes-related cardiovascular disease. The addition of sodium-glucose co-transporter inhibitors (SGLT2i) in treating these patients has seen improved mortality and hospital admission rates. As such, we felt it was important to investigate whether the use of SGLT2i improved functional capacity in patients with HF when compared to OMT by evaluating maximum oxygen consumption (peak VO2) using cardiopulmonary exercise testing (CPET). Methods: We found 94 heart failure patients between August 2020 and August 2021 who underwent CPET before and after treatment at Mayo Clinic in Florida. 50 patients received OMT and 44 received OMT and SGLT2i therapy. CPET results before and after were compared for each group. Results: The baseline ejection fraction was not significantly different between groups, with the OMT group at 38% and the SGLT2i group at 33%, p= 0.10. OMT patients were found to have a significantly lower hemoglobin A1c of 5.7 (5.4 – 6.1) compared to those with SGLT2i therapy of 6.4 (5.8 – 7.1), p= 0.01. The baseline peak VO2 was 17.3 ml/kg/min (13.3 – 21.6) in the OMT group and 17.3 ml/kg/min (14.4 – 18.9) in the SGLT2i group, p=0.18, not significantly different. The interesting finding is that the follow-up peak VO2 at one year for the OMT group was 17 ml/kg/min (13.3 – 21.6), which was not significantly different from the SGLT2i group peak VO2 of 17 ml/kg/min (14.6 – 19.6), p= 0.19. Our study is the first to compare before and after peak VO2 values of the OMT+SGLT2i group to the patient's own baseline and we found no significant improvement. Conclusion: Our single-center data shows no improvement in functional capacity after the addition of SGLT2i therapy to OMT in patients with advanced heart failure. Improved hospitalization and symptoms may be attributed to other numerous effects of SGLT2i such as volume management.

    Keywords: Heart Failure, diabetes, SGLT2I, Exercise Test, CpEt, functional capacity, transplant, VO2

    Received: 25 Jan 2024; Accepted: 03 Jun 2024.

    Copyright: © 2024 Desai, Sharma, Abuah, Jang, Desai, Paghdhar and Goswami. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Rohan Goswami, Mayo Clinic Florida, Jacksonville, United States

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.