Phd in ANGIO-CARDIO-THORACIC PATHOPHYSIOLOGY AND IMAGING

Thesis title: A comprehensive evaluation of cardiac reverse remodeling before and after SGLT2i therapy in a real-world cohort of patients with heart failure: an advanced imaging study.

BACKGROUND: Sodium-Glucose Transport Protein 2 Inhibitors (SGLT2i) have proven beneficial cardiac reverse remodeling (RR) effects in heart failure (HF) regardless of the ejection fraction (EF). Imaging studies focus mainly on the left ventricle (LV) or atrium (LA) with an existing gap in knowledge regarding the right ventricle (RV). In addition, there are no studies analysing the effect of sex on SGLT2i’s cardiac RR. PURPOSE: to assess the effect of SGLT2i on LV, LA and RV RR. The secondary aim was to analyse potential sex-based differences. METHODS: We enrolled HF patients naive to SGLT2i prior therapy commencing (on optimized HF therapy for at least 3 months). The LV, LA and RV dimensions and function were evaluated with both standard and advanced echocardiographic parameters, including speckle-tracking and hemodynamic forces (HDF). The NYHA Class and NT-proBNP were also collected. Patients were then divided according to sex and compared. RESULTS: Eighty-eight patients were recruited. Comparing echocardiographic parameters at T0 and T1 we found a significant improvement across the three chambers. The LVRR occurred in 37 patients (42%), the RVRR in 45 patients (51%), the biventricular remodeling in 20 patients (23%) and the LARR in 17 patients (19%). We found a comparable effect of cardiac RR in sex groups (p > 0,05). A significant reduction of NYHA Class and NT pro-BNP values were also observed. CONCLUSION: After 6 months of SGLT2i a significant cardiac RR involving all three chambers occurred, together with a realignment of HDFs, suggesting not only a structural remodeling but also an optimization of energetic efficiency. No significant differences in males and in females were detected. Long-term and randomized studies are necessary to confirm these findings.