A personalized approach to the treatment of patients with chronic heart failure with preserved ejection fraction and non-alcoholic fatty liver disease using dapagliflozin

Relevance. Recently, the attention of researchers has been focused on finding the pleiotropic effects of gliflozins, which include potential therapeutic efficacy against non-alcoholic fatty liver disease (NAFLD). NAFLD is considered not only as an independent risk factor for the development and progression of liver dysfunction, but also cardiovascular diseases. Objective. To evaluate the effect of dapagliflozin after 12 weeks of use on clinical and biochemical parameters, body composition and the degree of liver fibrosis in patients with chronic heart failure with preserved ejection fraction (HFpEF) in combination with NAFLD. Material and methods. A prospective, randomized, open-label study in parallel groups involving 60 patients with HFpEF in combination with NAFLD. The main group received dapagliflozin 10 mg once a day in addition to standard therapy for 12 weeks. The main evaluation parameters were biochemical parameters, non-invasive indices of liver fibrosis assessment, clinical manifestations of chronic heart failure (CHF) and body composition according to bioimpedance measurements. Results. In the main group, a statistically significant decrease in ALT from 48.5 [12.0; 66.0] to 29.5 [11.0; 46.0] U/L, p=0.031, AST - from 47.0 [21.0; 69.5] to 25.5 [10.0; 44.5] U/L, p=0.011), total bilirubin from 16.6 [7.6; 18.1] to 11.3 [3.6; 14.1] mmol/L, p=0.047 and TG - from 1.2 [0.8; 1.8] to 0.9 [0.8; 1.2] mmol/l, p=0.022; decrease in the FIB-4 index from 1.44 [0.94; 3.01] to 1.18 [0.64; 3.11], p=0.022; BARD scale - from 1 [0; 2] to 0 [0; 2], p=0.028; NFS scale - from -1.435 [-1.634; 0.665] to -1.616 [-1.852; 0.365], p=0.040; decrease in body mass index (BMI) from 29.6 [25.5; 33.1] to 27.1 [22.2; 31.0] kg/m 2 , p=0.047; waist circumference (WC) - from 99.5 [91.5; 104.5] to 96.5 [89.5; 100.5] cm, p=0.044 and percentage of body fat according to bioimpedancemetry - from 22.3 [19.5; 25.6] to 20.3 [17.4; 23.9]%, p=0.022. Dynamics of functional class CHF from II to I was revealed in the main group, p<0.05. Conclusion. Taking dapagliflozin for 12 weeks in patients with CHFpEF and NAFLD was accompanied by a decrease in liver transaminases, plasma TG, hepatoprotective antifibrotic effect (FIB-4 index, NFS and BARD scales), a decrease in BMI, WC and percentage of body fat, as well as regression of clinical symptoms of CHF.