Early hemodynamic impact of SGLT2 inhibitors in overweight cardiometabolic heart failure: beyond fluid offloading to vascular adaptation– a preliminary report
Cardiovascular Diabetology,
Год журнала:
2025,
Номер
24(1)
Опубликована: Март 26, 2025
Heart
failure
(HF)
is
increasingly
recognized
as
a
heterogeneous
cardiometabolic
disorder,
often
in
the
context
of
overweight/obesity
independently
from
diabetes.
Sodium-glucose
cotransporter-2
inhibitors
(SGLT2i)
reduce
HF
hospitalizations
and
cardiovascular
mortality
across
ejection
fraction
(EF)
categories,
yet
their
early
hemodynamic
effects
HF,
with
preserved
(HFpEF)
particular,
remain
underexplored.
A
prospective,
single-center
study
included
20
consecutive
patients
receiving
SGLT2i
alongside
optimized
therapy.
Transthoracic
echocardiography
non-invasive
bioimpedance
assessments
(NICaS
system)
were
performed
at
baseline
after
4
weeks.
The
median
patient
age
was
75
years
[58–84],
14
(70%)
being
overweight/obese,
only
majority
(65%)
had
EF
(HFpEF),
25%
mildly
reduced
(HFmrEF),
10%
(HFrEF).
At
follow-up
33
days
[30–68],
significant
reductions
observed
body
weight
(67.65
kg
[46-99.20]
to
65.50
[46.30–97],
p
=
0.027)
systolic
blood
pressure
(130
mmHg
[100–150]
116.50
[100–141],
0.015).
Hemodynamic
revealed
decrease
total
peripheral
resistance
index
(TPRi,
3616.50
dynes·sec·cm3
[1600–5024]
3098.50
[1608–4684],
0.002).
left
atrial
volume
decreased
significantly
(42.84
ml/m²
[27-69.40]
41.15
[26-62.60],
<
0.001);
peak
tricuspid
regurgitation
velocity
[2.52
m/Sect.
(1.30–3.20]),
vs.
2.21
(1.44–2.92),
0.023]
pulmonary
artery
(PASP)
[31.0
(15.0–40.0)
25.50
(15.0-38.0-),
0.010]
observed.
Patients
HFrEF
or
HFmrEF
showed
reduction
water
(66.33
[51.45–74.45]
58.68
[55.13–66.50]),
while
HFpEF
(overweight/obese,
n
11,
79%)
TPRi
(3681
3085
[1608–4684]
0.005).
Early
responses
may
differ
subtypes.
In
overweight
HFpEF,
our
preliminary
findings
suggest
an
association
vascular
resistance,
HFrEF/HFmrEF,
primary
benefit
appears
be
unloading.
However,
uncertain,
given
small
sample
size,
these
results
should
interpreted
hypothesis-generating.
Our
also
highlight
potential
role
monitoring
guiding
therapy
HF.
Язык: Английский
Metabolic rewiring and inter-organ crosstalk in diabetic HFpEF
Cardiovascular Diabetology,
Год журнала:
2025,
Номер
24(1)
Опубликована: Апрель 4, 2025
Heart
failure
with
preserved
ejection
fraction
(HFpEF)
represents
a
significant
and
growing
clinical
challenge.
Initially,
for
an
extended
period,
HFpEF
was
simply
considered
as
subset
of
heart
failure,
manifesting
haemodynamic
disorders
such
hypertension,
myocardial
hypertrophy,
diastolic
dysfunction.
However,
the
rising
prevalence
obesity
diabetes
has
reshaped
phenotype,
nearly
45%
cases
coexisting
diabetes.
Currently,
it
is
recognized
multi-system
disorder
that
involves
heart,
liver,
kidneys,
skeletal
muscle,
adipose
tissue,
along
immune
inflammatory
signaling
pathways.
In
this
review,
we
summarize
landscape
metabolic
rewiring
crosstalk
between
other
organs/systems
(e.g.,
adipose,
gut,
liver
hematopoiesis
system)
in
diabetic
first
instance.
A
diverse
array
metabolites
cytokines
play
pivotal
roles
intricate
process,
rewiring,
chronic
responses,
dysregulation,
endothelial
dysfunction,
fibrosis
identified
central
mechanisms
at
complex
interplay.
The
liver-heart
axis
links
nonalcoholic
steatohepatitis
through
shared
lipid
accumulation,
inflammation,
pathways,
while
gut-heart
dysbiosis-driven
trimethylamine
N-oxide,
indole-3-propionic
acid
short-chain
fatty
acids)
impacting
cardiac
function
inflammation.
Adipose-heart
highlights
epicardial
tissue
source
local
inflammation
mechanical
stress,
whereas
hematopoietic
system
contributes
via
cell
activation
cytokine
release.
We
contend
that,
based
on
viewpoints
expounded
breaking
inter-organ/system
vicious
cycle
linchpin
treating
HFpEF.
Язык: Английский