Although dapagliflozin may reduce death or worsening heart failure (HF) in patients with aortic stenosis (AS) undergoing TAVI, it showed limited improvement in patients’ health status post TAVI, according to a prespecified subanalysis of the DapaTAVI trial published Oct. 6 in JACC. Dapagliflozin may be most relevant in patients with a residual symptomatic burden.
A total of 964 patients from the DapaTAVI study group enrolled between January 2021 and December 2023 were included in this independent, investigator-initiated trial. Clara Bonanad-Lozano, MD, PhD, et al., used the Kansas City Cardiomyopathy Questionnaire (KCCQ) to assess the effect of dapagliflozin on health status post TAVI. Of note, the primary endpoint was the change in KCCQ score from baseline to one year. The mean baseline KCCQ score was 39.9 in the dapagliflozin group and 39.1 in the control arm (p=0.404).
Using an ordinal logistic regression model to analyze the primary endpoint, the authors assessed the change in KCCQ score from baseline to three and 12 months, as well as the effect of dapagliflozin on the composite of death or worsening HF by baseline KCCQ score.
Researchers found no significant differences in change of KCCQ score at three months (odds ratio [OR ], 0.96; p=0.745) or 12 months (OR, 1.03; p=0.819) between the two groups. Additionally, at 12-month follow-up, similar proportions of patients in the dapagliflozin and control groups showed clinically meaningful improvements, with 43.4% vs. 45.4%, respectively, improving by >50 points, highlighting that the clinical benefits of dapagliflozin after TAVI appeared to be similar across the full range of baseline KCCQ scores.
“…Our findings suggest that future trials should consider targeted inclusion criteria, such as patients with persistent congestion, elevated biomarkers or low KCCQ scores after TAVI, to better identify those patients who may benefit symptomatically from SGLT2 inhibition,” write the authors.
In an accompanying editorial comment, Chetan Prakash Huded, MD, FACC, et al., express their belief that “future studies should focus on patients who remain symptomatic after successful TAVR.” “…Only through such a multidisciplinary approach are we likely to fully achieve the fundamental goals of treatment in valvular heart disease – increasing longevity and optimizing health status,” they write.
