Ter Arkh. 2026 Feb 14;97(12):994-1002. doi: 10.26442/00403660.2025.12.203510.
ABSTRACT
AIM: To evaluate the efficacy and safety of the use of sodium-glucose cotransporter type 2 (SGLT-2) inhibitors in patients with chronic heart failure (CHF) due to amyloid cardiomyopathy (ACM).
MATERIALS AND METHODS: 50 patients with CHF due to different types of ACM were included and randomized in two groups at a ratio of 1:1. In the 1st group (n=25), SGLT-2 inhibitors were added to basic therapy. In the 2nd group (n=25) patients received only basic therapy. The observation period was 6 months. Clinical function status, laboratory marker dynamics, echocardiography parameters, frequency of hospitalizations and presence of cardiovascular events were evaluated.
RESULTS: SGLT-2 inhibitors therapy was well tolerated, safe. The frequency of hospitalizations due to decompensated heart failure was higher in the 2nd group (p=0.048), cases of hospitalization in the 2nd group occurred statistically significantly earlier (p=0.017). Mortality in the 1st group was 4% (1 case), in the 2nd group — 16% (4 cases), due to progressive CHF. In the 1st group, the distance of a 6-minute walk test increased (p<0.001), the quality of life assessed by the Minnesota Living with Heart Failure Questionnaire improved (p<0.001), the expression of shortness decreased (p<0.001), there was an improvement in clinical status according to the clinical assessment scale (p<0.001), while in the 2nd group there was a statistically significant deterioration of clinical functional status. The dynamics of the N-terminal pro-Brain Natriuretic Peptide and troponine levels were positive in the 1st group and negative in the 2nd group (p=0.001 and <0.001 respectively). Significant changes in the glomerular filtration rate in the 1st group were not detected (p=0.475), in the 2nd group there was a decrease of this parameter (p<0.001). According to the results of echocardiography in the 2nd group a significant reduction of the left ventricular (LV) ejection fraction (p=0.001) was observed, and in the 1st group was a tendency to decrease of the LV ejection fraction (p=0.238). Regardless of the SGLT-2 inhibitors intake, there was a decrease in the end-diastolic dimension of LV (p=0.046 for 1st group and <0.001 — for 2nd group), as well as a progressive thickening of heart walls (p=0.011 and <0.001 for interventricular septum thickness, p=0.004 and <0.001 — for posterior wall thickness of LV).
CONCLUSION: The administration of SGLT-2 inhibitors to patients with CHF due to ACM leads to an improvement in quality of life, a decrease in the frequency of hospitalizations due to decompensated heart failure of CHF, but does not affect mortality. Further study of therapeutic efficacy in more patients is needed.
PMID:41705611 | DOI:10.26442/00403660.2025.12.203510
