Background:

The improving and prognostic relevant effect of SGLT-2 inhibitors in patients with chronic heart failure has been previously shown. In this study, we aimed to evaluate the effect of SGLT-2 inhibitors on sympathetic nerve activity in patients with chronic heart failure. 

Methods:

We prospectively included 30 patients with chronic heart failure (LVEF< 50%). All patients underwent microneurography, comprehensive echocardiography inclusively blood tests before and 12 months after the start with a SGLT-2 inhibitor.

Microneurography was performed to assess sympathetic nerve activity as described previously; after local disinfection, a tungsten needle (200 µm) was introduced into the nervus peroneus longus close to the caput fibuli to record multiunit postganglionic sympathetic activity. Burst frequency (burst/min) and burst incidence (burst/beats) were generated from recorded data as MSNA-defining parameters.

Results:

30 patients (69.4 ± 12.3 years, 32 % female) with chronic heart failure (LVEF: 41.26 ± 8.32 %) without any relevant valvular disease or cardiac decompensation were prospectively included. Medical heart failure therapy was comparable between groups at baseline and at follow-up. 

At baseline, we found a significantly increased MSNA (101.3 ± 13.8 burst/min, 111.5 ± 8.9 bursts/beats, average value about 60 burst/min). 

Left ventricular function (LVEF: 46.23 ± 13.4%, p=0.05) was found to be significantly increased at follow-up. Correspondingly, we found improved MSNA (101.3 ± 13.8 burst/min to 87.8 ±18.2 burst/min, p=0.003; 111.5 ± 8.9 burst/beats to 91.1 ± 17.7 burst/beats p=0.05) at follow-up.

We documented no major events (mortality or hospitalization due to cardiac decompensation) during the follow-up.

Conclusion:

Sympathetic nerve activity was found to be significantly decreased under therapy with SGLT-2 inhibitor in patients with chronic heart failure in addition to improving effect on left ventricular function.