Dapagliflozin: Potential Role in Pediatric Cardiac Patient Care

Sodium-glucose cotransporter 2 inhibitors have demonstrated substantial cardiovascular and renal benefits in adults, including reduced heart failure events across diabetic and nondiabetic populations. However, pediatric cardiac data remain limited, and real-world use is increasing in specialized centers despite the absence of standardized pediatric protocols. We synthesized a literature review, which was conducted using multiple databases, covering records available through January 2026, to include studies reporting cardiovascular outcomes in children with heart failure receiving dapagliflozin. Given the heterogeneity in study designs and endpoints, findings were synthesized qualitatively without conducting a meta-analysis. Six key studies were identified: 1 open-label pilot randomized trial, 1 prospective cohort, 3 retrospective cohorts, and 1 case series, encompassing heterogeneous etiologies, including dilated cardiomyopathy, myocarditis-related cardiomyopathy, congenital heart disease/Fontan physiology, and post-transplant graft dysfunction. Across observational cohorts, dapagliflozin was associated with modest improvements in ventricular function and frequent improvement in New York Heart Association/Ross functional class. Natriuretic peptide responses were variable, with reductions that were inconsistent. The pilot randomized trial did not demonstrate significant between-group differences in composite clinical outcomes or key cardiac measures over a 6-month period. Reported adverse events were predominantly genitourinary infections and transient renal events, with few discontinuations and no consistent signal of ketoacidosis, severe hypoglycemia, or clinically significant hypotension. Available data suggest a potential signal for modest improvement in cardiac function and clinical status, alongside an overall reassuring short-term safety profile. Multicenter prospective studies with standardized endpoints are needed to define efficacy, optimal patient selection, and long-term safety in pediatric cardiac care.