Carly Adamson at SCMH @ESC Congress 2022

Image of Carly Adamson

Carly Adamson was delighted to present a poster and abstract at the ESC Congress. First was a moderated poster, examining the effect of elevation in bilirubin and alkaline phosphates on outcomes in HFrEF using data from the ATMOSPHERE and PARADIGM-HF trials. Patients with elevation of both markers were at high risk of adverse outcomes, perhaps reflecting more significant congestion.

Secondly she presented results from an analysis of IGFBP-7 in patients with HFrEF in the DAPA-HF trial. This is a biomarker of interest in heart failure, thought to be linked to myocardial fibrosis, decreased chamber compliance and may reflect diastolic dysfunction. Elevation in IGFBP-7 was associated with more severe heart failure at baseline. Elevation was associated with greater risk of adverse outcomes, even after adjustment for NT-proBNP and high sensitivity troponin-T.

Dapagliflozin for heart failure according to body mass index: the DELIVER trial

Lastly she was involved in a subgroup analysis of the DELIVER trial of dapagliflozin compared with placebo in patients with HFpEF and HFmrEF looking at the effect of body mass index, which was one of the many papers simultaneously published at the time of the main results being presented. Obesity was common in this study, and patients gained benefit from dapagliflozin regardless of baseline.

Background and Aims

Obesity is common and associated with unique phenotypic features in heart failure with preserved ejection fraction (HFpEF). Therefore, understanding the efficacy and safety of new therapies in HFpEF patients with obesity is important. The effects of dapagliflozin were examined according to body mass index (BMI) among patients in DELIVER.

Methods

BMI was analyzed by World Health Organization (WHO) categories and as a continuous variable using restricted cubic splines.

Results

BMI ranged from 15.2 to 50 kg/m2 with a mean value of 29.8 (SD ± 6.1) kg/m2. The proportions, by WHO category, were: normal weight 1343 (21.5%); overweight 2073 (33.1%); class I obesity 1574 (25.2%); class II obesity 798 (12.8%); class III obesity 415 (6.6%). Compared to placebo, dapagliflozin reduced the risk of the primary outcome to a similar extent across these categories: hazard ratio (95% confidence interval) 0.89 (0.69-1.15), 0.87 (0.70-1.08), 0.74 (0.58-0.93), 0.78 (0.57-1.08), and 0.72 (0.47-1.08), respectively (P-interaction = 0.82). The placebo-corrected change in Kansas City Cardiomyopathy Questionnaire total symptom score with dapagliflozin at 8 months was: 0.9 (-1.1, 2.8), 2.5 (0.8, 4.1), 1.9 (-0.1, 3.8), 2.7 (-0.5, 5.8), and 8.6 (4.0, 13.2) points, respectively (P-interaction = 0.03). The placebo-corrected change in weight at 12 months was: -0.88 (-1.28, -0.47), -0.65 (-1.04, -0.26), -1.42 (-1.89, -0.94), -1.17 (-1.94, -0.40), and -2.50 (-4.4, -0.64) kg (P-interaction = 0.002).

Conclusions

Obesity is common in patients with HFpEF and is associated with higher rates of heart failure hospitalization and worse health status. Treatment with dapagliflozin improves cardiovascular outcomes across the spectrum of BMI, leads to greater symptom improvement in patients with obesity, compared to those without, and has the additional benefit of causing modest weight loss.

Link to Paper

 

 


First published: 31 August 2022