Clinical and Biochemical Responses to SGLT2 (Sodium-Glucose Cotransporter-2) Inhibitors in Patients With Rheumatic Heart Disease and Heart Failure

Background: Rheumatic heart disease (RHD) remains the third most common cause of heart failure in India, which bears the highest global burden of RHD.Left untreated or poorly managed, RHD culminates in heart failure, posing substantial challenges for clinical management.Despite advances in interventional management, the therapeutic landscape for heart failure in patients with RHD remains inadequately explored, particularly with respect to sodium-glucose cotransporter-2 (SGLT2) inhibitors.Methods: This hospital-based study enrolled 90 patients with chronic RHD and New York Heart Association (NYHA) functional class II-IV heart failure.All patients received standard heart failure therapy, with SGLT2 inhibitors added according to the study protocol.Baseline evaluation included clinical assessment and measurement of serum N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.Patients were followed for three months, and changes in NYHA functional class and serum NT-proBNP levels were assessed.Results: At three months following initiation of SGLT2 inhibitor therapy, significant improvements were observed in both clinical and biochemical parameters.The mean serum NT-proBNP level decreased significantly from 1,687.0 ± 897.8 pg/mL at baseline to 1,212.6 ± 606.6 pg/mL at follow-up (p < 0.001).Improvement in NYHA functional class was noted in 44 (48.9%) patients, while 41 (45.6%) patients remained clinically stable with no change in functional class.Five (5.6%) patients experienced worsening of NYHA functional class during follow-up.Overall, the change in NYHA functional class was statistically significant (p < 0.001).Conclusion: Our findings suggest that the addition of SGLT2 inhibitors to standard heart failure therapy was associated with significant improvement in NYHA functional class and a significant reduction in NT-proBNP levels over three months.