SGLT-2 Inhibitors Improve Cardiac Function and Symptoms in Hypertrophic Cardiomyopathy: Study

A new study published in the journal of Frontiers in Cardiovascular Medicine revealed that Sodium–glucose cotransporter 2 inhibitors (SGLT-2i) were associated with improved left ventricular diastolic function and better New York Heart Association (NYHA) functional class in patients with hypertrophic cardiomyopathy (HCM).

HCM is marked by thickening of the heart muscle (left ventricle) which often leads to impaired relaxation of the heart and diastolic dysfunction. Patients frequently experience shortness of breath, fatigue, and reduced exercise capacity. While SGLT-2i have been proven effective in managing heart failure, their role in HCM has remained largely unexplored.

This research analyzed data from patients with HCM admitted between January 2021 and December 2024. After applying propensity score matching (PSM) to ensure comparable groups, 94 patients who initiated SGLT-2i therapy were matched with 94 control patients who did not receive the medication. The study focused on changes in echocardiographic measures and NYHA functional class at six months, with heart failure readmission tracked through June 2025.

At six months, patients treated with SGLT-2 inhibitors demonstrated significantly greater improvements in key markers of diastolic function when compared to controls. Septal e′ velocity (measure of myocardial relaxation) improved by an average of 0.7 cm/s in the treatment group versus 0.04 cm/s in controls (p = 0.002). The E/e′ ratio, an indicator of left ventricular filling pressures, declined by 5.1 points in the SGLT-2i group compared to a slight increase of 0.4 in controls (p < 0.001). Also, interventricular septal thickness (IVST) was reduced more substantially in treated patients (−1.3 mm vs. −0.2 mm, p = 0.005).

The patients receiving SGLT-2 inhibitors experienced a greater reduction in NYHA class, reflecting better symptom control and exercise tolerance (p = 0.031). Multivariate analysis confirmed that improvements in septal e′, E/e′ ratio, and NYHA class remained statistically significant after adjusting for potential confounders. Over a median follow-up of 16.3 months, 20 patients in the SGLT-2i group and 17 in the control group were readmitted for heart failure (log-rank p = 0.73), suggesting that longer-term outcomes may require further investigation.

No hypoglycemic events were reported, and there was no significant deterioration in renal function, the two concerns commonly monitored with SGLT-2 inhibitor use. Overall, the findings suggest that SGLT-2 inhibitors may improve diastolic function and symptom burden in patients with HCM without increasing safety risks.

Source:

Ding, C., Lv, F., Wang, L., & Xu, X. (2026). SGLT-2 inhibitors improve cardiac function in hypertrophic cardiomyopathy: a real-world propensity score-matched study. Frontiers in Cardiovascular Medicine, 13(1742682). https://doi.org/10.3389/fcvm.2026.1742682