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Lorenzo M, Jacobs-Cachá C, Palau P, Amiguet M, Seller J, Núñez E, Espriella RDL, Górriz JL, Miñana G, Sanchis J, Bayés-Genis A, Soler MJ, Packer M, Núñez J. Short-Term Changes in Peak VO 2 After Initiation of Dapagliflozin in Heart Failure Across Iron Status. JACC Heart Fail 2023; 11:1611-1622. [PMID: 37676213 DOI: 10.1016/j.jchf.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Some studies have indicated that sodium-glucose cotransporter-2 (SGLT2) inhibitors promote an increase in cell iron use. OBJECTIVES The aim of this study was to examine, in patients with stable heart failure with reduced left ventricular ejection fraction (HFrEF), the effect of dapagliflozin on ferrokinetic parameters and whether short-term changes in peak oxygen consumption (Vo2) after dapagliflozin treatment are influenced by baseline and serial ferrokinetic status. METHODS This was an exploratory analysis of a randomized, double-blind clinical trial that evaluated the effect of dapagliflozin vs placebo on peak Vo2 in patients with HFrEF (NCT04197635) and included 76 of the 90 patients initially enrolled in the trial. Changes in peak Vo2 at 1 and 3 months were explored according to baseline and longitudinal ferrokinetic parameters (natural logarithm [ln] ferritin, transferrin saturation index [TSAT], soluble transferrin receptor, and hepcidin). Linear mixed-effect regression was used for the analyses. RESULTS Compared with placebo, dapagliflozin led to a significant decrease in 3-month ln ferritin (P = 0.040) and an increase in 1-month ln soluble transferrin receptor (P = 0.023). Between-treatment comparisons revealed a stepwise increase in peak Vo2 in the dapagliflozin group at 1 and 3 months, which was especially apparent at lower baseline values of TSAT and ferritin (P < 0.05). Lower time-varying values of TSAT (1 and 3 months) also identified patients with greater improvements in peak Vo2. CONCLUSIONS In patients with stable HFrEF, treatment with dapagliflozin resulted in short-term increases in peak Vo2, which were most marked in patients with surrogates of greater iron deficiency at baseline and during treatment. (Short-Term Effects of Dapagliflozin on Peak Vo2 in HFrEF [DAPA-VO2]; NCT04197635).
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Affiliation(s)
- Miguel Lorenzo
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain
| | | | - Patricia Palau
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain
| | - Martina Amiguet
- Cardiology Department, Hospital General Universitario de Castellón, Castellón de la Plana, Spain
| | - Julia Seller
- Cardiology Department, Hospital de Dénia-Marina Salud, Alicante, Spain; Fundación Para Fomento de Investigación Sanitaria y Biomédica CV-Fisabio, Valencia, Spain
| | | | - Rafael de la Espriella
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain
| | - Jose Luis Górriz
- Universitat de València, Valencia, Spain; Nephrology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Gema Miñana
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Antoni Bayés-Genis
- CIBER Cardiovascular, Madrid, Spain; Cardiology Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | | | - Milton Packer
- Baylor Heart and Vascular Institute, Dallas, Texas, USA
| | - Julio Núñez
- Cardiology Department, Hospital Clínico Universitario de Valencia, Valencia, Spain; INCLIVA, Valencia, Spain; Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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