Impact of Sodium Glucose Cotransporter 2 Inhibitors on Pulmonary Artery Pressure in Patients with Heart Failure and Pulmonary Hypertension and its Relation to Red Blood Cell Distribution Width

Background: Sodium glucose cotransporter 2 inhibitor (SGLT2i) is established for heart failure (HF) patients, regardless of type 2 diabetes mellitus (DM).Objectives: This study investigates the effect of SGLT2i on pulmonary artery pressure (PAP), right ventricular (RV) function, and red blood cell distribution width (RDW) in HF patients with pulmonary hypertension (PH) with or without DM.Patients and methods: A randomized controlled trial included 100 patients (≥ 16 years) with HF (ejection fraction < 40%) and PH, divided into two groups: 50 receiving SGLT2i plus optimal medical therapy (OMT) and 50 receiving OMT alone. Patients underwent 2D echocardiography and RDW measurement at baseline and after 6 months. The outcome of pre-post intervention alterations was compared to the results of the control group of patients with the same criteria and on optimal medical therapy without SGLT2I.Results: After 6 months, SGLT2i treatment led to significant improvements in RV function (RV FAC, TAPSE, PAT) and reductions in left ventricular diameters and volumes (P < 0.05). The RV parameters were significantly higher in the SGLT2i group compared to the control group (P < 0.05). RDW increased significantly in the SGLT2i group (P = 0.001).Conclusion: In patients with HF and PH with or without T2DM, SGLT2I had a greater impact on PH and RV function compared to optimal medical treatment alone without SGLT2I.