Safety and Efficacy of Adding Dapagliflozin to Furosemide in Type 2 Diabetic Patients With Decompensated Heart Failure and Reduced Ejection Fraction.

Background: Heart failure is the most common cause of hospitalization in elderly patients. It is likely that many of the mechanisms that contribute to reductions in systolic and diastolic function, seen in diabetic patients, place them at an increased risk of heart failure. Diuretic therapy, especially loop diuretics, is the usual way of managing congestion, particularly in volume-overloaded patients. Little is known about the beneficial effect of dapagliflozin when added to loop diuretics in managing patients with decompensated heart failure. Aim: To assess the effect of the addition of dapagliflozin to furosemide in managing decompensated patient with heart failure and reduced left ventricular ejection fraction in terms of weight loss and dyspnea improvement. Patients and Methods: The study included 100 type 2 diabetic patients who were admitted with decompensated heart failure. The study population was randomly divided into two arms. Serum electrolytes and kidney functions were followed up during their hospital stay. Results: With dapagliflozin, there was a statistically significant difference between the two groups regarding the change in body weight and body mass index. The diuresis parameters including urine output, total fluid loss, and fluid balance also showed a statistically significant difference in favor of the use of dapagliflozin, with no significant change in serum potassium or kidney functions. There was significant improvement in patient-reported dyspnea scores with the use of dapagliflozin. Conclusions: Dapagliflozin may provide a new drug option in the treatment of heart failure especially among vulnerable group of diabetics. It had no remarkable effects on serum potassium level and kidney functions. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT04385589.

Effect of time delay of PDA closure on the aortic stiffness index and its relationship with cardiac function.

BACKGROUND: Patent ductus arteriosus (PDA) causes volume overload of the left side of the heart. Stiffening in the larger central arterial system, such as the aortic tree, significantly contributes to cardiovascular diseases in older individuals and is positively associated with systolic hypertension and coronary artery disease. In this study, we evaluated the effect of time delay of PDA closure on aortic stiffness and its relationship with cardiac function before and after transcatheter closure of the PDA. METHODS: Our study population consisted of 60 children who were scheduled for transcatheter closure of the PDA. They were divided into two groups as follows: group A in whom PDA closure was performed before the age of one year, and group B in whom PDA closure was performed after the age of one year. RESULTS: Before PDA closure, the aortic stiffness index (ASI) was significantly higher in children in group B than in those in group A (p < 0.001), and was it significantly higher in both groups than in the control group (p < 0.001). CONCLUSIONS: Aortic stiffness was significantly elevated in patients with PDA, even small-sized PDAs, and was associated with impairment in cardiac function, particularly if PDA closure was delayed after the age of one year.

Aortic stiffness index and its association with cardiovascular functions in children before and after transcatheter closure of PDA.

BACKGROUND: Patent ductus arteriosus is generally associated with hyperdynamic status. Given the vascular shunt between the aorta and pulmonary artery, intrinsic aortic changes occur (aortic stiffness). In the present study, we attempted to assess the impact of PDA on aortic stiffness and its connection with cardiovascular function before and after transcatheter closure of PDA. PATIENT AND METHODS: Our study consisted of 60 children who were preparing for transcatheter closure of PDA and 60 healthy controls. All patients had clinical and echocardiographic proof of hemodynamically significant PDA. RESULTS: Patients with PDA exhibited significantly higher ASI than controls before closure (p-value < 0.05). After closure, ASI was significantly reduced (p-value < 0.05), but still higher than that of controls (p-value < 0.05) at the six-month follow-up assessment. Patients with PDA had significantly lower LVEF than controls before closure (p-value < 0.05). After closure, LVEF was significantly enhanced (p-value < 0.05), and no significant difference was noted amongst patients and controls (p-value < 0.05) at the six-month follow-up assessment. CONCLUSION: Aortic stiffness is significantly increased in patients with PDA regardless of PDA size. Aortic stiffness is related to reduced heart function. ASI may be valuable for observing the course of patients with PDA before and after intervention.