Echocardiographic effects of sodium-glucose cotransporter 2 inhibitors in single ventricle circulatory failure

• Published in: International journal of cardiology congenital heart disease Vol. 21; p. 100603
• Main Authors: Neijenhuis, Ralph M.L., Regeer, Madelien V., Walker, Niki L., Hunter, Amanda, Kiès, Philippine, Holman, Eduard R., Jukema, J. Wouter, Jongbloed, Monique R.M., Veldtman, Gruschen R., Egorova, Anastasia D.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2025; Elsevier
• Subjects: Cardiovascular; Congenital heart disease; Echocardiography; Fontan; Heart failure; Original; Single ventricle circulatory failure; Sodium-glucose cotransporter 2 inhibitors; Univentricular; Heart failure; Univentricular; Echocardiography; Congenital heart disease; Sodium-glucose cotransporter 2 inhibitors; Single ventricle circulatory failure; Fontan
• ISSN: 2666-6685; 2666-6685
• DOI: 10.1016/j.ijcchd.2025.100603

Single ventricle patients are at high risk of developing circulatory failure. There is limited evidence for pharmacological treatment. This study assessed the echocardiographic changes in ventricular function during sodium-glucose cotransporter 2 inhibitor (SGLT2i) therapy in patients with single ventricle failure (SVF). SVF patients with a baseline transthoracic echocardiogram within six months before starting SGLT2i and at least one echocardiographic examination within twelve months follow-up were included from a real-world international registry of adult congenital heart disease patients on SGLT2i. Mixed models were used to evaluate longitudinal changes in ventricular function and differences between patients with SVF with ≥ moderately reduced systolic function (SVFrEF) and with ≤ mildly reduced function (SVFpEF). Thirteen patients were included. The median age was 21 [20–42] years, 8 (61.5 %) were female, 10 (76.9 %) had a Fontan circulation, 8 (61.5 %) had SVFrEF, and 5 (38.5 %) SVFpEF at the start of SGLT2i. The mean follow-up was 7.6 ± 3.3 months. End-systolic area decreased significantly in all patients (−1.6 cm2 per month, p = 0.007) in the first 100 days. Fractional area change improved in the first 100 days in SVFrEF patients (3.5 %-point per month, p < 0.001), while SVFpEF patients remained stable. There was a significant improvement in the free wall strain in all patients (−0.3 %-point per month, p = 0.036) but not in global longitudinal strain (p = 0.087). Isovolumic acceleration also improved in the first 100 days (0.5 m/s2 per month, p = 0.010). Echocardiographic signals of improved ventricular function were observed in the first year of SGLT2i therapy in patients with SVF. [Display omitted] •The effects of SGLT2i in single ventricle failure (SVF) are unknown.•Mixed models were utilized for real-world repeated measurement analyses.•Although cautious, there are signs of improved ventricular function after SGLT2i.•SVF patients with reduced systolic function might benefit more from SGLT2i.•Future studies should evaluate SVF phenotype-specific responses to SGLT2i.