Written by Peter Liu
Spoon Feed
Dapagliflozin reduced heart failure worsening or death in patients undergoing trancatheter aortic valve replacement (TAVR) with comorbid diabetes, ejection fraction (EF) <40%, or moderate renal insufficiency.
SGLT2 inhibitor therapy maintains its benefit in patients undergoing TAVR
Across heart failure (HF) RCTs, including both preserved- and reduced-EF trials, SGLT2 inhibitors have been shown to reduce the risk of heart failure exacerbations by roughly 25%. Isolated studies such as DAPA-HF have also shown a significant mortality benefit, though this finding is not as consistent across all HF studies.
In the DapaTAVI RCT, 1,222 high-risk patients undergoing TAVR were studied to evaluate if dapagliflozin reduced composite death or worsening heart failure (i.e. HF exacerbation). All patients had previous HF episodes related to their aortic stenosis, plus either diabetes, EF <40%, or eGFR 25 to 75. At 1-year follow-up, the primary composite outcome occurred in 15.0% of the dapagliflozin group vs. 20.1% with standard care (HR 0.72; 95%CI, 0.55–0.95; P=0.02). This finding was driven predominantly by a reduction in HF worsening (9.4% vs. 14.4%; sHR 0.63; 95%CI, 0.45–0.88). Patients receiving dapagliflozin had more genital infections (e.g. yeast infection) (1.8% vs 0.5%; P=0.03) and hypotension (6.6% vs 3.6%; P=0.01).
Notably, this RCT did not utilize placebo in the control arm. Nonetheless, the study offers valuable insight for patients over 80 (72% of participants) and patients with aortic stenosis, who are generally underrepresented in other SGLT2i HF trials. Overall, these findings support generalizing the use of dapagliflozin for the majority of HF patients undergoing TAVR.
How does this change my practice?
Overall, findings from DapaTAVI continue to broaden the population of heart failure patients who clearly benefit from SGLT2 inhibitor use. However, the increased incidence of genital infections and hypotension replicate known risks observed in prior trials suggesting a patient population with contraindications to SGLT2i therapy.
Source
Dapagliflozin in Patients Undergoing Transcatheter Aortic-Valve Implantation. N Engl J Med. 2025 Apr 10;392(14):1396-1405. doi: 10.1056/NEJMoa2500366. Epub 2025 Mar 29. PMID: 40162639
