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Mortality and Heart Failure Benefits of SGLT2 Inhibitors in Transthyretin Amyloid Cardiomyopathy: A Cohort and Integrated Meta-Analysis
Session:
Sessão de Posters 15 - Prognóstico, estratificação de risco e comorbilidades na amiloidose cardíaca
Speaker:
Emídio Mata
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.4 Myocardial Disease – Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Emídio Mata; Bernardo Resende; Luísa Pinheiro; Margarida Castro; Bárbara Lage Garcia; Tamara Pereira; Filipa Cordeiro; Olga Azevedo; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Background: </span></strong><span style="font-size:11.0pt">The evidence supporting sodium–glucose cotransporter-2 inhibitors (SGLT2i) in heart failure (HF) secondary to transthyretin amyloid cardiomyopathy (ATTR-CM) remains scarce and fragmented across small observational series.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Aim: </span></strong><span style="font-size:11.0pt">To evaluate the impact of SGLT2i on clinical outcomes in ATTR-CM through a single-center cohort study, integrating results into a meta-analysis of available evidence.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Methods: </span></strong><span style="font-size:11.0pt">A retrospective cohort of patients with ATTR-CM (2014–2024, n=111) was analyzed, comparing those treated with SGLT2i versus non-treated. The primary endpoint was all-cause mortality (ACM); secondary endpoints included heart failure hospitalizations (HFH) and the composite of ACM and HFH. A time-varying treatment exposure Cox regression, adjusted for 12 baseline covariates, was used to account for confounding and immortal-time bias. A systematic search of CENTRAL, Scopus, EMBASE, and PubMed (October 10, 2025) identified studies evaluating SGLT2i effects </span><span style="font-size:11.0pt">on outcomes of interest </span><span style="font-size:11.0pt">in ATTR-CM. Hazard ratios (HRs) were extracted or converted from relative risks, prioritizing covariate-adjusted or propensity-matched estimates. </span><span style="font-size:11.0pt">Data were pooled using inverse-variance random-effects meta-analyses to estimate overall effects</span><span style="font-size:11.0pt">.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Results: </span></strong><span style="font-size:11.0pt">In the institutional cohort, time-varying analysis demonstrated lower ACM among SGLT2i users (HR 0.35, 95% CI 0.13–0.97; p=0.04) over a median 25-month follow-up (IQR 16–39). </span><span style="font-size:11.0pt">Rates of HFH and the composite outcome did not differ significantly between patients treated with SGLT2i and those not receiving SGLT2i therapy.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt">The meta-analysis pooled data from 4 observational studies and the institutional cohort (n</span><span style="font-size:11.0pt">=</span><span style="font-size:11.0pt"> 5909). SGLT2i use was associated with reduced ACM (pooled HR 0.56, 95% CI 0.46–0.68; I² = 24%), fewer HFH (HR 0.66, 95% CI 0.51–0.86; I² = 30%), and lower risk of the composite outcome (HR 0.55, 95% CI 0.38–0.80; I² = 0%). No significant heterogeneity or small-study effects were detected.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-size:11.0pt">Conclusions: </span></strong><span style="font-size:11.0pt">SGLT2i therapy in transthyretin amyloid cardiomyopathy (ATTR-CM) was associated with significant reductions in ACM and HFH in pooled analyses, consistent with findings from the institutional cohort. These results support the emerging role of SGLT2i as a potentially disease-modifying adjunct in the management of ATTR-CM and highlight the need for confirmation in prospective randomized trials.</span></span></span></p>
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