Retrospective Analysis Of GLP-1 Receptor Agonist Use And Hemodynamic Trends In Heart Failure Patients With Cardiomems HF System

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Author Block: Ireoluwatomiwa Opayemi¹, Guangyu Tong², Yukang Zeng², Sara Tabtabai³, Christopher Maulion⁴. ¹Yale University School of Medicine; ²Yale University School of Medicine, New Haven, CT; ³Yale New Haven Health System, Farmington, CT; ⁴Yale New Haven Health System, New Haven, CT
Disclosure Block: I. Opayemi: None.

Background: Recent trials of GLP-1 receptor agonists and dual GLP-1 and GIP in patients with obesity and HFpEF have shown fewer worsening HF events, and decreased inflammatory and cardiac biomarkers, suggesting direct cardiac benefits of these agents. However, limited data exists on their direct hemodynamic effects in patients with obesity and HF. This study evaluated the effects of GLP-1 and dual GLP-1 and GIP on hemodynamic parameters measured by CardioMEMs HF system, loop diuretic requirements and HF hospitalizations.
Methods: This multicenter retrospective analysis included a manual chart review and employed the Yale Joint Data Analytics Team (JDAT) database. Patients with HF implanted with the CardioMEMs HF system within the Yale New Haven Health System who had received either semaglutide or tirzepatide for at least 6 months during the study period were included. Baseline demographics, PA pressures, weight, loop diuretic use (calculated in furosemide equivalents) and biomarkers were measured at baseline, 3 and 6 months after initiation of either treatment. Significant cardiac events, including HF hospitalizations and urgent care visits, were recorded 1 year prior to and 1 year following initiation. For continuous outcomes (PA pressures, weight), within-patient changes from baseline to 3 and 6 months were assessed using paired t-tests among participants with complete paired observations at each time point. HF event rates before versus after initiation were compared using paired t-tests on per-patient annualized counts. The association between weight change and PA pressure change was evaluated using the Pearson correlation coefficient (r).
Results: Of 506 patients implanted with the CardioMEMs HF; a total of 60 patients were included for analysis: semaglutide (n=48) or tirzepatide (n=12). Mean age was 63.7 ± 14.5 years, 65% were male, and mean baseline weight was 116 ± 25 kg. From a baseline PA systolic pressure of 46 ± 13 mmHg, significant reductions were observed at both 3 months (-2.75 ± 7.37 mmHg, p=0.02; n=42) and 6 months (-3.74 ± 8.47 mmHg, p=0.01; n=35). PA mean pressure decreased by -2.67 ± 5.55 mmHg (p=0.007) and PA diastolic pressure by -1.70 ± 3.95 mmHg (p=0.02) at 6 months. Weight decreased by -2.77 ± 4.10 kg (-2.3%) at 3 months and -5.19 ± 7.23 kg (-4.4%) at 6 months (both p<0.001). Loop diuretic use decreased from 85% to 67% at 6 months, with no significant change in furosemide equivalent dosing (p=0.26). HF hospitalizations decreased from 1.20 ± 1.42 to 0.30 ± 0.62 per year (p<0.001). The correlation between changes in weight and PA pressure was modest(r=0.18, p=0.34).
Conclusion: Initiation of GLP-1 or dual GLP-1 and GIP agonists in patients with HF led to measurable reduction in PA pressures. The weight reduction observed was notably lower in comparison to previous cardiovascular outcome trials. Despite the relatively modest weight loss, this cohort showed a notable decrease in HF hospitalizations. Study limitations include missed follow-up measures and retrospective nature of the analysis. Additional research is warranted to elucidate the mechanisms underlying these treatments in HF and obesity.