The role of sodium glucose cotransporter or glucagon-like peptide-1 receptor agonists in treating heart failure with preserved ejection fraction in patients with type 2 diabetes mellitus

Abstract

Background. Heart failure with preserved ejection fraction is not a single disease but a clinical syndrome secondary to important comorbidities, is increasing in prevalence, and is associated with high functional impairment. This study aimed to compare the results of treating patients with heart failure with preserved ejection fraction and type 2 diabetes mellitus with sodium-glucose cotransporter inhibitors (SGLT-2 inhibitors) or Glucagon-like peptide-1 receptor agonists (GLP-1 RAs). Methods. Observational trial in one medical center with assessments at baseline and 6 months. Participants were patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction. The primary endpoint was to measure the impact of treatment on weight loss, diastolic dysfunction, Kansas City Cardiomyopathy Questionnaire. We performed anthropometric measurements, blood samples and transthoracic echocardiography for systolic and diastolic dysfunction. Results. After 6 months of intervention, both groups had a significant increase in results of Kansas City Cardiomyopathy Questionnaire, and the mean change in the group treated with GLP-1 Ras was 15.88 ± 7.7 points (95% confidence interval[CI], 19.7-12.7, p<0.01) while in the group treated with sodium-glucose cotransporter inhibitors was 13.57 ± 7.96 points (95% confidence interval[CI], 16.22-10.91, p<0.01) so the quality of life was better. The weight loss was more important in the group with GLP-1 Ras with 5.8 ± 1.8 kg (95% confidence interval [CI], 4.7-7.0, p<0.01) while in the other group was 1.37 ± 1.4 kg (95% confidence interval [CI], 0.54-2.21, p<0.01). Diastolic dysfunction was improved in monitoring E/E' lateral and was 3.28 ±1.27 less (95% confidence interval [CI], 2.75-3.80, p<0.01) in the GLP-1 Ras group and 2.93 ± 2.15 less (95% confidence interval [CI], 2.21-3.64, p<0.01) in the SGLT-2 inhibitors group. Conclusions. The present study establishes an improvement in symptoms, diastolic dysfunction, and weight loss in patients with type 2 diabetes mellitus and heart failure with preserved ejection fraction and treatment with GLP-1 Ras or SGLT-2 inhibitors.

Keywords

• heart failure with preserved ejection fraction (hfpef)
• diabetes mellitus type 2 (t2dm)
• n‐terminal pro–b‐type natriuretic peptide (ntprobnp)
• glucagon-like peptide-1 receptor agonists (glp-1 ras)
• sodium glucose cotransporter inhibitors (sglt-2 inhibitors)