(1042) Safety and Tolerability of Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i) in Patients Supported with Left Ventricular Assist Devices

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; pp. S450 - S451
• Main Authors: Chavali, S., Barua, S., Adjii, A., Robson, D., Raven, L., Greenfield, J., Parvar, S., MacDonald, P., Hayward, C., Muthiah, K.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.04.2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.1253

Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have evolved into a pillar of the heart failure therapy regimen, but their safety and tolerability in end-stage heart failure patients supported with left-ventricular-assist-devices (LVADs) has not been well-studied. We retrospectively analysed the electronic medical records of outpatients who were implanted with LVADs as bridge-to-transplant (BTT) at our institution between October 2020 and August 2022. Data on demographic profile, renal function (estimated glomerular filtration rate, eGFR) hemocompatibility related adverse events (stroke, pump thrombosis, gastrointestinal bleeding, other bleeding) and infection (sepsis, driveline infection) were analysed. Sixteen of 31 patients (51.6%) were prescribed SGLT2i, mean exposure duration of 132.7 ± 118.8 days. There were no significant differences in baseline demographics (age, weight, LVAD type, diabetes, renal function) between SGLT2i and non-SGLT2i groups. On pairwise analysis, neither group experienced significant change in eGFR from first to last clinic visits, SGLT2i 84.7 ± 25.3 to 70.1 ± 24.2 mL/min/1.73m2, p=0.11 vs non-SGLT2i group, 85.8 ± 25.8 to 72.9 ± 20.8 mL/min/1.73m2, p=0.14. In the SGLT2i group, there was no significant change in eGFR from time of SGLT2i initiation to last clinic visit, p= 0.06. Weight profile did not change significantly with SGLT2i use (88.8 ± 21.3 to 90.1 ± 14.5 kg, p=0.85). There were numerically lower hemocompatibility and infection-related adverse events in the SGLT2i group, 7 events vs 11 events. One-year freedom from adverse events is shown in Figure 1. SGLT2i are well-tolerated in BTT patients supported with LVADs with no significant difference in both renal function and adverse events in the medium-term. The effect of SGLT2i in attenuating the known decline in renal function over the long-term warrants further study.