Clinical and echocardiographic management of patients with Chronic Heart Failure and Type 2 Diabetes Mellitus: the SCODIAC Follow up Study
Abstract Background SCODIAC study revealed an increasing use of SGLT2 inhibitors in 123 patients affected with Heart Failure (HF) and Type 2 Diabetes Mellitus (T2DM), referred to Cardiologists and Diabetologists of the pertaining healthcare districts. SCODIAC Follow Up, the second phase of the program, has been carried out to determine diagnostic and therapeutic pathways in a larger group of HF diabetic patients and to verify whether the use of innovative antidiabetic therapies could modify echocardiographic parameters and influence cardiological therapy. Methods 406 patients affected with HF and T2DM, referred to Cardiologists and Diabetologists of pertaining healthcare districts in Campania, and followed for at least one year between 2018 and 2019, were enrolled in this retrospective study and divided in Group A, composed of 136 HF diabetic patients with preserved Ejection Fraction (HF-pEF) (> 45%) and Group B, formed of 270 HF diabetic patients with reduced EF (HF-rEF) (≤ 45%). All patients had performed periodic clinical evaluations and an echocardiographic exam every 12 months. Anthropometric parameters, HF etiology, co-morbidities, complications and ongoing therapies were collected. Results The clinical and laboratory parameters and the treatments adopted were assessed at beginning and after 12 months of treatment. The antidiabetic therapies resulted modified after one year with a greater use of GLP1 AR, gliptins and SGLT2i. Cardiological therapy resulted also modified with a greater use of ARNI and a reduction of ACE inhibitors and ARBs in HF-rEF patients. At the end of the study echocardiography E velocity, A velocity and E/E’ ratio resulted markedly reduced in 25 HF-pEF patients and in 60 HF-rEF patients treated with SGLT2i, in respect to both the whole sample of subjects at beginning and the other diabetic patients, while LAVi resulted reduced only in HF-pEF patients and EF increased only in HF-rEF patients. Conclusions The approach to the patients with HF and T2DM must necessarily take place in the healthcare districts and be multidisciplinary and integrated in order to tailor therapy to the characteristics of the patient. SGLT2i could improve left ventricular function in HF-rEF patients and modify cardiological therapeutic approach, almost in this setting of patients. Trial registration: The protocol was approved by the University of Naples Federico II Ethics Committee and registered at ClinicalTrial.gov (CT04375943). The principles outlined in the Declaration of Helsinki were followed.