AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Association of Sodium-Glucose Cotransporter 2 Inhibitor Use with Mitral Regurgitation Reduction and Cardiac Remodeling After Mitral Transcatheter Edge-to-Edge Repair Across Mitral Regurgitation Mechanisms
By Enwere C, Mousavi RA, Saeedullah U et al.
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve outcomes in heart failure, but their association with mitral regurgitation (MR) reduction and reverse remodeling after mitral transcatheter edge-to-edge repair (MTEER) remains unclear. Aim: The purpose of this study was to evaluate whether baseline SGLT2-inhibitor use was associated with post-MTEER MR response and echocardiographic remodeling across MR mechanisms. Methods: Patients undergoing MTEER were stratified by baseline SGLT2-inhibitor use. MR severity was assessed at baseline and one-year follow-up. Change in MR severity was calculated as follow-up minus baseline grade, with more negative values indicating greater MR reduction. Outcomes included follow-up MR severity, residual MR ≥ moderate, follow-up MR ≤ mild, any MR improvement, and changes in left ventricular ejection fraction (LVEF), left atrial volume index (LAVI), left ventricular end-diastolic volume index (LVEDVi), left ventricular end-systolic volume index (LVESVi), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and left ventricular mass index (LVMi). Multivariable models were adjusted for relevant clinical and echocardiographic characteristics. Results: Among 361 patients (mean age 79.2 ± 10.3 years; 51.8% female), 58 (16%) were receiving SGLT2 inhibitors and 303 (84%) were not. Baseline MR severity was similar between groups. At one year follow-up, SGLT2-inhibitor use was associated with lower MR severity (1.29±0.83 vs 1.65±0.80; p=0.003), greater MR reduction (-2.13±1.08 vs -1.81±0.93; p=0.009), lower residual MR ≥ moderate (38% vs 60%; p=0.006), and more frequent follow-up MR ≤ mild (62% vs 38%; p=0.002). After adjustment, SGLT2-inhibitor use remained associated with lower odds of residual MR ≥ moderate (OR 0.44, 95% CI 0.21-0.92; p=0.030). By mechanism, the association was most evident in secondary MR, where SGLT2-inhibitor use was associated with greater MR reduction (-2.20±0.97 vs -1.88±0.90; p=0.043) and more frequent follow-up MR ≤ mild (58% vs 38%; p=0.048), with numerically lower residual MR ≥ moderate (42% vs 61%; p=0.074). In primary MR, SGLT2-inhibitor use was associated with more frequent follow-up MR ≤ mild (63% vs 31%; p=0.023). SGLT2-inhibitor use was not significantly associated with changes in LVEF, LAVI, LVEDVi, LVESVi, LVEDD, LVESD, or LVMi. Conclusions: Baseline SGLT2-inhibitor use was independently associated with lower residual MR after MTEER at one-year follow-up. This association appeared most prominent in secondary MR, without significant independent associations with echocardiographic reverse remodeling. These findings support prospective evaluation of SGLT2 inhibitors as potential modifiers of post-MTEER MR response.