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Abstract
Aims
Sodium‐glucose cotransporter type 2 inhibitors (SGLT‐2i) represent a unique class of anti‐hyperglycaemic agents for type 2 diabetes mellitus that selectively inhibit renal glucose reabsorption, thereby increasing urinary excretion of glucose. Several studies have demonstrated the cardioprotective effects of SGLT‐2i in patients with heart failure (HF), unrelated to its glucosuric effect. It is unclear whether the benefits of SGLT‐2i therapy also rely on the improvement of left ventricular (LV) and/or right ventricular (RV) function in patients with HF. This study aimed to evaluate the effect of SGLT‐2i on LV and RV function through conventional and advanced echocardiographic parameters with a special focus on RV function in patients with HF.
Methods and results
The Biventricular Evaluation of Gliflozins effects In chroNic Heart Failure (BEGIN‐HF) study is an international multicentre, prospective study that will evaluate the effect of SGLT‐2i on echocardiographic parameters of myocardial function in patients with chronic stable HF across the left ventricular ejection fraction (LVEF) spectrum. Patients with New York Heart Association Class II/III symptoms, estimated glomerular filtration rate > 25 mL/min/1.73 m2, age > 18 years, and those who were not previously treated with SGLT‐2i will be included. All patients will undergo conventional, tissue‐derived imaging (TDI), and strain echocardiography in an ambulatory setting, at time of enrolment and after 6 months of SGLT‐2i therapy. The primary endpoint is the change in LV function as assessed by conventional, TDI, and myocardial deformation speckle tracking parameters. Secondary outcomes include changes in RV and left atrial function as assessed by conventional and deformation speckle tracking echocardiography. Univariate and multivariate analyses will be performed to identify predictors associated with primary and secondary endpoints.
Conclusions
The BEGIN‐HF will determine whether SGLT‐2i therapy improves LV and/or RV function by conventional and advanced echocardiography in patients with HF irrespective of LVEF.
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Details
1 Department of Cardiology, University Hospital Ospedali Riuniti, Foggia, Italy
2 ICCU, Emergency Institute for Cardiovascular Diseases ‘C.C. Iliescu’, Bucharest, Romania, The University for Medicine and Pharmacy ‘Carol Davila’, Bucharest, Romania
3 Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
4 Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
5 Department of Cardiology, Santa Maria della Misericordia University Hospital, Perugia, Italy
6 Department of Cardiovascular Medicine, Niigata University School of Medicine and Dental Sciences, Niigata, Japan
7 Department of Medicine, Di Lorenzo Clinic, Avezzano, Italy, Department of Cardiology, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
8 University Cardiology Unit, Policlinico University Hospital, Bari, Italy
9 Department of Cardiology, Santissima Annunziata Hospital, Taranto, Italy
10 Division of Cardiology, ‘La Memoria’ Hospital, Gavardo (Brescia), Italy
11 Pulse Heart Institute, Spokane, WA, USA, University of Washington, Spokane, WA, USA
12 Department of Internal Medicine‐Cardiology, Charité Universitäts Medizin, Berlin, Germany
13 Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
14 Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA, Baylor Scott and White Research Institute, Dallas, TX, USA