Right Ventricular–Pulmonary Artery Coupling Predicts Early Myocardial Strain Improvement in SGLT2 Inhibitor-Treated HFrEF

Abstract

Background: While sodium-glucose cotransporter-2 (SGLT2) inhibitors clearly benefit left ventricular recovery in heart failure with reduced ejection fraction (HFrEF), their rapid effects on right ventricular (RV) function remain poorly characterized. This prospective observational study investigated the timeline and markers of biventricular changes shortly after SGLT2 inhibitor initiation. Methods: In this prospective observational study, 50 adults with HFrEF (LVEF <40%) on optimal guideline-directed therapy underwent baseline and 3-month assessments after SGLT2 inhibitor initiation. Clinical parameters, functional capacity, and comprehensive echocardiography-including speckle-tracking-were evaluated. Results: = 0.546). ROC analysis demonstrated that a baseline TAPSE/PASP ratio ≥0.39 predicted RV functional response (AUC 0.84; sensitivity 76%, specificity 84%). Conclusions: In this prospective observational study without a control group, SGLT2 inhibitor initiation was associated with coordinated biventricular improvements within three months in HFrEF patients. The baseline TAPSE/PASP ratio may serve as a useful non-invasive predictor of early RV functional recovery. These preliminary findings require confirmation in larger controlled studies.