Safety and tolerability of sodium-glucose cotransporter-2 inhibitors in bridge-to-transplant patients supported with centrifugal-flow left ventricular assist devices.

Aug 14, 2023

Experts: Sanjay Chavali,Sumita Barua,Audrey Adji,Desiree Robson,Lisa M Raven,Jerry R Greenfield,Hunter Eckford,Peter S Macdonald,Christopher S Hayward,Kavitha Muthiah

The safety and tolerability of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in patients with end-stage heart failure supported with left-ventricular-assist-devices (LVADs), irrespective of diabetes mellitus, is not known.
A retrospective analysis of 31 outpatients implanted with LVADs as bridge-to-transplant (BTT) was conducted. Patients with biventricular support, aged under 18 years, who were discharged from the index hospitalisation, or were prescribed SGLT2i prior to their first outpatient clinic were excluded. Patient demographics, laboratory studies, pump haemodynamic and adverse event data was collected.
Sixteen (51.6%) of 31 patients were prescribed SGLT2i over median 101.5 days (37.5-190.8). No patients discontinued SGLT2i use or reported attributable adverse symptoms. No significant differences between patients prescribed SGLT2i compared to those SGLT2i-naïve were seen in: [1] renal function; [2] weight; [3] mean arterial pressure. There were numerically lower infection-related (n = 4 vs 7, HR 0.32 (0.08-1.28), p = 0.11) and haemocompatibility-related (n = 3 vs 4, HR 0.52 (0.09-2.83), p = 0.45) adverse events in the SGLT2i group, albeit non-significant.
We found SGLT2i to be safe and well-tolerated in the BTT LVAD cohort with no significant difference in rates of infection or haemocompatibility-related adverse events with SGLT2i use. Larger studies will inform further beneficial effects of SGLT2i prescription in this cohort.

Copyright © 2023. Published by Elsevier B.V.

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ABOUT THE EXPERTS

Sanjay Chavali,Sumita Barua,Audrey Adji,Desiree Robson,Lisa M Raven,Jerry R Greenfield,Hunter Eckford,Peter S Macdonald,Christopher S Hayward,Kavitha Muthiah

Sanjay Chavali

St Vincent’s Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia.

Sumita Barua

St Vincent’s Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia.

Audrey Adji

St Vincent’s Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia.

Desiree Robson

St Vincent’s Hospital, Sydney, Australia.

Lisa M Raven

St Vincent’s Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Clinical Diabetes, Appetite and Metabolism Laboratory, Garvan Institute of Medical Research, Sydney, Australia.

Jerry R Greenfield

St Vincent’s Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Clinical Diabetes, Appetite and Metabolism Laboratory, Garvan Institute of Medical Research, Sydney, Australia.

Hunter Eckford

St Vincent’s Hospital, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia.

Peter S Macdonald

St Vincent’s Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia.

Christopher S Hayward

St Vincent’s Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia.

Kavitha Muthiah

St Vincent’s Hospital, Sydney, Australia; School of Clinical Medicine, St Vincent’s Campus, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia. Electronic address: kavitha.muthiah@svha.org.au.