# Case Series Evaluating the Relationship of SGLT2 Inhibition to Pulmonary Artery Pressure and Non-Invasive Cardiopulmonary Parameters in HFpEF/HFmrEF Patients—A Pilot Study

## TL;DR

This pilot study found no significant changes in pulmonary artery pressure or cardiopulmonary parameters in HFpEF/HFmrEF patients after starting SGLT2 inhibitors.

## Contribution

The study is a pilot investigation into the effects of SGLT2 inhibitors on pulmonary hemodynamics in HFpEF/HFmrEF patients using telemonitoring and non-invasive methods.

## Key findings

- No significant changes in pulmonary artery pressure, PVR, PCWP, or RV-PA coupling were observed after SGLT2 inhibitor initiation.
- PVR values were closely correlated across three methods, but PCWP methods lacked reliable association.
- Non-invasive calculation of PVR showed consistency, but PCWP remained unreliable.

## Abstract

The initiation of sodium–glucose cotransporter 2 (SGLT2) inhibitor treatment was shown to reduce pulmonary artery pressure (PAP) in New York Heart Association (NYHA) class III heart failure (HF) patients with an implanted PAP sensor. We aimed to investigate the impact of SGLT2-I initiation on pulmonary vascular resistance (PVR), pulmonary capillary wedge pressure (PCWP), pulmonary arterial capacitance (PAC), and right ventricle (RV) to PA (RV-PA) coupling in a pilot cohort of HF with preserved/mildly reduced ejection fraction (HFpEF/HFmrEF) patients and whether PVR and PCWP can be serially calculated non-invasively using PAP sensor data during follow-up. Methods: Right heart catheterization parameters (PVR, PCWP, and PAC) were obtained at sensor implantation and echocardiographic assessments (E/E’, RV-PA coupling, and RV cardiac output) were made at baseline and every 3 months. SGLT2 inhibition was initiated after 3 months of telemedical care. Three methods for calculating PVR and PCWP were compared using Bland–Altman plots and Spearman’s correlation. Results: In 13 HF patients (mean age 77 ± 4 years), there were no significant changes in PAP, PVR, PCWP, RV-PA coupling, or PAC over 9 months (all p-values > 0.05), including after SGLT2-I initiation. PVR values were closely correlated across the three methods (PVRNew and PVRNew Tedford (r = 0.614, p < 0.001), PVREcho and PVRNew Tedford (r = 0.446, p = 0.006), and PVREcho and PVRNew (r = 0.394, p = 0.016)), but PCWP methods lacked reliable association (PCWPEcho and PCWPNew (r = 0.180, p = 0.332). Conclusions: No changes in cardiopulmonary hemodynamics were detected after hemodynamic telemonitoring either prior to or following SGLT2-I initiation. Different PVR assessment methods yielded comparable results, whereas PCWP methods were not associated with each other. Further investigations with larger cohorts including repeated right heart catheterization are planned.