SYSTEMIC AND PULMONARY HEMODYNAMIC EFFECTS OF SGLT2 INHIBITORS IN HEART FAILURE WITH COEXISTING LUNG DISEASE

Background: To evaluate the systemic and pulmonary hemodynamic effects of SGLT2 inhibitors in patients with chronic HF and coexisting lung disease. Methods: This prospective observational study included 72 patients with HF and chronic lung disease treated at Gomal Medical College and its affiliated hospital between January 2023 and January 2024. Baseline and six-month follow-up assessments included clinical evaluation, echocardiographic measurements of systemic and pulmonary pressures, pulmonary function tests, NT-proBNP levels, and six-minute walk distance (6MWD). Statistical comparisons were made using paired t-tests and McNemar’s test. Results: Mean systolic and diastolic blood pressures decreased significantly after therapy (128.4 ± 12.7 to 122.1 ± 11.9 mmHg, p = 0.004; 78.5 ± 8.4 to 74.9 ± 7.8 mmHg, p = 0.011), while cardiac output increased (4.21 ± 0.82 to 4.56 ± 0.87 L/min, p = 0.022). Pulmonary artery systolic pressure and mean pulmonary artery pressure declined (p < 0.001 for both), alongside reductions in ‘pulmonary vascular resistance and pulmonary capillary wedge pressure’. NT-proBNP levels fell significantly (1832 ± 651 to 1427 ± 604 pg/mL, p < 0.001), and 6MWD improved by a mean of 34 meters (p < 0.001). Pulmonary function parameters showed no significant change. Conclusion: In HF patients with chronic lung disease, SGLT2 inhibitors improved both systemic and pulmonary hemodynamics, enhanced exercise capacity, and reduced cardiac biomarker levels without adversely affecting lung function. These findings support their role as a valuable addition to therapy in this complex patient group.