Potential hematopoietic effects of SGLT2 inhibitors in patients with cardiac amyloidosis.

Sodium–glucose cotransporter 2 inhibitors (SGLT2i) have been revealed to have potential hematopoietic effects in patients with heart failure (HF), leading to an improvement in clinical outcome. However, these benefits have not been studied in patients with cardiac amyloidosis (CA). We aimed to determine the potential of SGLT2i in improving hematological parameters and functional capacity in amyloidosis patients. A prospective analysis was conducted to compare the effects of SGLT2i in a cohort of patients who received the best medical therapy (BMT) alongside SGLT2i (n=20), as opposed to patients receiving only BMT without SGLT2i (n=20). All of patients underwent blood testing and cardiopulmonary exercise testing (CPET) at baseline and after 6 months (IQR:5.0 – 6.0). The SGLT2i-based therapy resulted in a significant improvement and difference in hematological parameters upon follow-up assessment compared to the control group. In the SGLT2i group, the mean hemoglobin level increased from 13.3 g/dL to 14.5 g/dL (P < 0.001). Furthermore, the hematocrit difference showed a significant increase in the SGLT2i group compared to a decrease in the control group (P < 0.001). Additionally, the iron status improved in the SGLT2i-treated group (+6.7 µg/dL), although the difference was significant only with a p-value of 0.034. There was no significant change in either group in the peak oxygen consumption (peak VO2, (ml/min)/kg) (P = 0.286), as well as VE/VCO2 slope (P = 0.295). Treatment with SGLT2i could be utilized in the treatment of patients with amyloidosis. This potential benefit in improving hematological parameters warrants further investigation in clinical practice.