TOPLINE:

The DapaTAVI trial previously showed reduced rates of death or worsening heart failure with dapagliflozin in older adults with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). A substudy of the trial reported substantial improvements in health status and quality of life after TAVI, with no measurable benefit from adding dapagliflozin.

METHODOLOGY:

• Researchers reported findings from a substudy of the prospective, open-label DapaTAVI trial assessing the impact of the SGLT2 inhibitor dapagliflozin on patient-reported health status and quality of life after TAVI.
• DapaTAVI was conducted in Spain and included patients with severe aortic stenosis undergoing TAVI who had a prior heart failure episode related to aortic stenosis and met at least one criterion: moderate renal insufficiency, diabetes, or left ventricular ejection fraction ≤ 40%.
• Within 14 days after TAVI, patients were randomly assigned to receive 10 mg of dapagliflozin once daily or standard care without an SGLT2 inhibitor.
• Health status and quality of life in 964 patients were assessed before TAVI and at 3 and 12 months via telephone interviews using the Kansas City Cardiomyopathy Questionnaire (KCCQ), with higher overall summary scores on the KCCQ indicating better health. The mean age of patients in both groups was 82.6 years, and 49.5% of the dapagliflozin group and 47.2% of the standard care group were women.
• Researchers evaluated whether the KCCQ overall summary score before TAVI influenced the composite outcome of death or worsening heart failure. A secondary analysis evaluated changes in New York Heart Association (NYHA) functional class.

TAKEAWAY:

• The mean KCCQ score before TAVI was 39.9 in patients who received dapagliflozin and 39.1 in those who received standard care, with no significant difference between the groups.
• Both groups achieved rapid and sustained, but similar, improvements in KCCQ overall summary scores at 3 and 12 months after TAVI. At 12 months, scores improved by more than 20 points in 70% of the dapagliflozin group and 70.8% in the standard care group.
• The reduction in the composite endpoint of death or worsening heart failure with dapagliflozin after TAVI was similar regardless of the KCCQ overall summary score before TAVI.
• In a secondary analysis, patients on dapagliflozin were more likely to show improvement in NYHA functional class at 3 and 12 months (P < .05 for both).

IN PRACTICE:

“Taken together, these findings suggest that although dapagliflozin retains prognostic benefits post-TAVI, its effects on health status may be limited in patients who experience dramatic symptom improvement following valve replacement,” the researchers of the study wrote.

“[W]e do not believe these results should discount the potential health status benefits of SGLT2 inhibitors after [transcatheter aortic valve replacement] TAVR. Instead, we believe that future studies should focus on patients who remain symptomatic after successful TAVR,” experts wrote in an editorial comment accompanying the journal article.

“Although the ‘job’ of structural interventionalists may be successfully executed with a good procedural result, patients need to be treated as individuals who may need both a valve intervention and additional heart failure treatment,” they added.

SOURCE:

This study was led by Clara Bonanad-Lozano, MD, PhD, of Clinic University Hospital of Valencia in Valencia, Spain. It was published online on October 06, 2025, in the Journal of the American College of Cardiology.

LIMITATIONS:

This study had an open‑label design; hence, measures rated by clinicians such as NYHA class might be affected by expectation bias. KCCQ was measured only at certain timepoints, and short-term changes may have been missed. The trial was conducted only in Spain, limiting generalizability to broader populations.

DISCLOSURES:

This study reported receiving support from multiple sources, including the Institute of Health Carlos III, Gerenzia Regional de Salud de la Junta de Castilla y Leon y Fondos, the Spanish Society of Cardiology, and the Galician Society of Cardiology. One author reported receiving a research contract and a grant from the Carlos III Health Institute, and another author reported receiving support from the European Commission.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.