Effect of diuretic down-titration on pulmonary congestion assessed by lung ultrasound when introducing sodium-glucose cotransporter 2 inhibitors

Abstract Background Mechanistic pathways of sodium-glucose cotransporter 2 inhibitors (SGLT2i) benefits in heart failure (HF) remain unclear. Purpose To investigate the effects SGLT2i and simultaneous diuretic down-titration on pulmonary congestion assessed by lung ultrasound (LUS) HF biomarkers. Methods Prospective observational study outpatients with type diabetes assigned to a SGLT2i. LUS was performed at baseline (just before starting SGLT2i), 15 days 3-months follow-up. Eight thoracic areas were examined. Diuretic regime reduced baseline, when clinical assessment allowed. The main outcome short-time change B-lines sum. Secondary endpoints evaluated N-terminal pro-B-type natriuretic peptide (NTproBNP), cancer antigen 125 (CA125) interleukin-1 receptor-like 1 (ST2) Results 88 patients included (age, 66.8±9.9 years; 93.2% male; 77.3% NYHA II functional class; 75% treated loop diuretics). median lines B (RIQ 1–4), 1–4) 0–4) initial visit, 3 months, respectively (initial vs. p=0.21) (Table 1). number diuretics decreased from 66 33 (p<0.001) mean dose furosemide (or equivalent) those who continued 61±5 mg/day 45.8±20 (p<0.001). There no hospitalizations for months None biomarkers showed statistically differences follow-up Conclusions introduction allowed significant reduction chronic diabetes, without evidence worsening neither nor Funding Acknowledgement Type funding sources: None.