Use of sodium-dependent glucose cotransporter inhibitors for the treatment of chronic heart failure (literature review and clinical case)

Abstract

There is insufficient data on various aspects of the effect
of sodium-dependent glucose cotransporter 2 (SGLT2) inhibitors
on the course of chronic heart failure, as well as the features of
lipid-lowering therapy in the case of a clinically significant decrease
in renal filtration capacity. The aim was to access effectiveness of
treatment with SGLT2 inhibitors at high-risk cardiovascular patients.
Matherial and methods. A literature review was conducted in the
Pubmed database for the last 5 years and a clinical case was provided.
Results. It was found that the use of SGLT2 inhibitors in patients
with chronic heart failure, regardless of the presence or absence of
diabetes mellitus and functional capacity of the kidneys, reduced
hospitalization and mortality with maximum efficiency within the
ejection fraction of 41-65%, which is proven by evidence-based
medicine data (EMPEROR-reserved, EMPEROR-Reduced, DAPA-HF).
The mechanisms by which heart function improved with the use of SGLT2 are still unclear. The effectiveness of SGLT2 in patients with
cardiac pathology without diabetes mellitus with chronic heart failure
and preserved ejection fraction, which occurs in about half of
cases, is ongoing. Gliflozins play a role in modulating the response
to inflammation, oxidative stress, cellular energy metabolism, systemic
regulatory processes, control hyperglycemia, ketogenesis,
natriuresis, and hyperuricemia. A clinical case of dapaglyflozin use
for one year showed an increase in left ventriclular ejection fraction,
a decrease of wall hypertrophy and dilation of cardiac chambers,
an improvement in renal function and carbohydrate metabolism.