Association between chronic sodium-glucose cotransporter 2 inhibitors use and right ventricular function in hemodynamically stable patients with acute pulmonary embolism

Background Acute pulmonary embolism (PE) is a common cardiovascular disorder associated with substantial morbidity and mortality, with prognosis largely determined by the extent of right ventricular (RV) involvement. Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve outcomes in patients with heart failure (HF) and exert favorable effects on left ventricular (LV) remodeling; however, their effects on RV function in acute PE remain largely unexplored. We hypothesized that chronic treatment with SGLT2 inhibitors would be associated with a lower incidence of clinical congestion and a more favorable clinical course in patients with acute PE. Methods We retrospectively compared 30 patients receiving chronic SGLT2 inhibitor therapy with 90 controls following 1:3 matching for multiple variables, including age, sex, comorbidities, and background medical therapy. Echocardiographic and clinical outcomes were compared between the groups, including tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (SPAP), and clinical congestion. Results Patients receiving SGLT2 inhibitors had higher TAPSE values (19.4 ± 2.7 vs. 17.3 ± 5, 95% Confidence interval (CI) 0.7–3.5, p = 0.004), fewer signs of clinical congestion [6.7% vs. 25.6%, Odds ratio (OR) 0.21, 95% CI 0.05–0.94, p = 0.03], lower troponin, [14.5 (5.3–51), vs. 64.5 (20–177), 95% CI (33–108), p < 0.001], and lower N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, [158 (96–443) vs. 1000 (333–3433), 95% CI (467–1153) pg/mL, p < 0.001]. No significant between-group difference was observed in 1-year readmissions due to dyspnea or clinical congestion [OR 0.34, 95% CI (0.1–1.2), p = 0.13]. Conclusions Among hemodynamically stable patients with acute PE, chronic SGLT2 inhibitor therapy was associated with more favorable RV function during the index event; however, this association did not translate into improved long-term clinical outcomes. These findings warrant confirmation in prospective studies.