Management of patients with chronic heart failure and type 2 diabetes mellitus: the SCODIAC-II study
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Management of patients with chronic heart failure and type 2 diabetes mellitus: the SCODIAC‑II study Mariarosaria De Luca1,3 · Giorgio Bosso2 · Antonio Valvano2 · Vincenzo Guardasole1,3 · Amodio Botta3 · Vincenzo Carbone2 · Giovanni Carella2 · Andrea Del Buono3 · Giuseppe Di Giovanni3 · Biagio Fimiani2 · Franco Guarnaccia2 · Emanuela Lapice3 · Emilia Martedì3 · Giuseppe Memoli3 · Domenica Oliva3 · Geremia Romano3 · Antonio Cittadini1 · Giovanni Battista Zito2 · Ugo Oliviero1,2 Received: 11 July 2020 / Accepted: 1 October 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Abstract SCODIAC was a pilot study which revealed an increasing use of SGLT2i in 123 outpatients affected with Heart Failure (HF) and Type 2 Diabetes Mellitus. SCODIAC-II study, the second phase of the program, has been carried out to determine diagnostic and therapeutic pathways in a larger group of patients and to verify whether the use of innovative antidiabetic therapies could modify echocardiographic parameters and cardiovascular therapies. 406 HF-diabetic patients, referred to Cardiologists and Diabetologists of pertaining healthcare districts in Campania, were enrolled in this retrospective study and divided in Group A, composed of 136 patients with preserved Ejection Fraction (HF-pEF)(> 45%) and Group B, formed of 270 patients with reduced EF (HF-rEF)(≤ 45%). All patients had performed periodic clinical and echocardiographic evaluations. The antidiabetic therapies resulted modified after 1 year with a greater use of GLP1-AR, gliptins and SGLT2i. Cardiovascular therapies resulted also modified with a greater use of sacubitril/valsartan and a reduction of ACEi and ARBs in HF-rEF patients. Echocardiography E velocity, A velocity and E/e’ ratio resulted markedly reduced in 25 HF-pEF and in 60 HF-rEF patients treated with SGLT2i, in respect to both the whole sample of subjects at beginning and the other diabetic patients. LAVi resulted reduced only in HF-pEF patients and EF increased only in HF-rEF patients. The approach to the patients with HF and diabetes must necessarily take place in the healthcare districts, be multidisciplinary and integrated. SGLT2i could improve left ventricular function in HF-rEF patients and modify cardiovascular therapies, almost in this setting of patients. Trial registration The protocol was approved by the University of Naples Federico II Ethics Committee and registered at ClinicalTrial.gov (CT04375943). The principles outlined in the Declaration of Helsinki were followed. Keywords Heart failure · Diabetes · Echocardiography · Ejection fraction Abbreviations ACE-I Angiotensin-converting enzyme inhibitors AMD Associazione Medici Diabetologi ARB Angiotensin receptor blockers ARCA Associazioni Regionali Cardiologi Ambulatoriali BNP Brain natriuretic peptide
* Ugo Oliviero [email protected] 1
Department of Translational Medical Sciences, University Federico II, Via Pansini, 5, 80131 Naples, Italy
2
ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
3
AMD
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