Effects of Sodium-glucose Co-transporter-2 Inhibitors on Pulmonary Hypertension in Heart Failure with Preserved Ejection Fraction

Background: Treatment options for pulmonary hypertension (PH) associated with heart failure (HF) with preserved ejection fraction (HFpEF) remain limited.Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are a novel class of medications for HF, demonstrating efficacy regardless of diabetes status.These agents may lower left ventricular filling pressures, potentially reducing pulmonary pressure and enhancing right ventricular function.This study assessed the impact of SGLT2i on PH-HFpEF. Aim:The aim of this study is to assess the impact of SGLT2i on echocardiographic and biochemical markers in patients with PH associated with HFpEF.Study Design: This is a retrospective cohort study involving nine patients diagnosed with PH-HFpEF, treated at Pamukkale University.The study examines the changes in echocardiographic parameters and biochemical markers, specifically NT-proBNP levels, following long-term treatment with SGLT2i.Methods: A retrospective analysis was conducted on nine patients with PH-HFpEF between April 2018 and October 2020.All exhibited echocardiographic features of HFpEF, had both pre-and postcapillary PH, and were treated with SGLT2i for a median duration of 27 months following standard HF therapy.Seven patients had a history of HF-related hospitalization, and PH was confirmed via right heart catheterization in five cases.Follow-up echocardiography was performed after at least 12 months of SGLT2i treatment. Results:The mean patient age was 67 years, with a predominance of women (66%), and all had diabetes.Following SGLT2i initiation, none required hospitalization for HF.Hemodynamic parameters improved, including reductions in mean right atrial and pulmonary arterial pressures, decreased pulmonary vascular resistance, and enhancements in cardiac index and oxygen saturation.Additionally, tricuspid regurgitation velocity and N-terminal pro-brain natriuretic peptide levels significantly declined, indicating improved cardiac function. Conclusion:Despite the high morbidity and mortality associated with this patient population, the findings suggest that SGLT2i may alleviate ventricular filling pressures, thereby reducing pulmonary pressures and potentially improving right ventricular function.Larger randomized trials are necessary to confirm these results.