Combined effects of ARNI and SGLT2 inhibitors in diabetic patients with heart failure with reduced ejection fraction

• Published in: Scientific reports 2021-11, Vol.11 (1), p.22342-22342, Article 22342
• Main Authors: Kim, Hyue Mee, Hwang, In-Chang, Choi, Wonsuk, Yoon, Yeonyee E., Cho, Goo-Yeong
• Format: Article
• Language: English
• Subjects: 692/4019; 692/4019/592/75/230; Aged; Aged, 80 and over; Angiotensin; Angiotensin Receptor Antagonists - administration & dosage; Cardiovascular diseases; Congestive heart failure; Diabetes; Diabetes mellitus; Diabetes Mellitus, Type 2 - diagnostic imaging; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - physiopathology; Echocardiography; Ejection fraction; Female; Glucose transporter; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - drug therapy; Heart Failure - physiopathology; Humanities and Social Sciences; Humans; Male; Middle Aged; Mortality; multidisciplinary; Neprilysin; Patients; Retrospective Studies; Science; Science (multidisciplinary); Sodium-Glucose Transporter 2 Inhibitors - administration & dosage; Stroke Volume; Ventricle
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-021-01759-5

Angiotensin receptor-neprilysin inhibitor (ARNI) and sodium–glucose co-transporter-2 inhibitor (SGLT2i) have shown benefits in diabetic patients with heart failure with reduced ejection fraction (HFrEF). However, their combined effect has not been revealed. We retrospectively identified diabetic patients with HFrEF who were prescribed an ARNI and/or SGLT2i. The patients were divided into groups treated with both ARNI and SGLT2i (group 1), ARNI but not SGLT2i (group 2), SGLT2i but not ARNI (group 3), and neither ARNI nor SGLT2i (group 4). After propensity score-matching, the occurrence of hospitalization for heart failure (HHF), cardiovascular mortality, and changes in echocardiographic parameters were analyzed. Of the 206 matched patients, 92 (44.7%) had to undergo HHF and 43 (20.9%) died of cardiovascular causes during a median 27.6 months of follow-up. Patients in group 1 exhibited a lower risk of HHF and cardiovascular mortality compared to those in the other groups. Improvements in the left ventricular ejection fraction and E/e′ were more pronounced in group 1 than in groups 2, 3 and 4. These echocardiographic improvements were more prominent after the initiation of ARNI, compare to the initiation of SGLT2i. In diabetic patients with HFrEF, combination of ARNI and SGT2i showed significant improvement in cardiac function and prognosis. ARNI-SGLT2i combination therapy may improve the clinical course of HFrEF in diabetic patients.