Dapagliflozin Benefit Generally Consistent Across LVEF Range

Dapagliflozin reduced the risk of all-cause death or worsening heart failure after transcatheter aortic valve implantation (TAVI), with the benefit generally consistent across baseline left ventricular ejection fraction (LVEF), according to a prespecified DapaTAVI trial analysis published in the European Journal of Heart Failure.

DapaTAVI was a pragmatic, multicenter, randomized, open-label trial with blinded endpoint adjudication conducted at 39 centers in Spain. Within 14 days after TAVI, participants received dapagliflozin 10 mg once daily or standard care without a sodium-glucose cotransporter-2 inhibitor. The analysis included 1,223 participants with baseline LVEF measurements; 213 had LVEF of 40% or less, and 1,010 had LVEF above 40%.

At 1 year, the primary composite occurred in 20.2% of participants with LVEF of 40% or less and 17.0% of those with higher LVEF. Treatment estimates favored dapagliflozin in both groups, with no significant interaction between treatment and the dichotomized LVEF categories (P for interaction=0.407). Modeling LVEF continuously also showed a homogeneous treatment effect on the primary composite.

However, additional analyses identified some variation in the magnitude of benefit. A significant interaction was observed for worsening heart failure when LVEF was modeled continuously (P for interaction=0.047), suggesting a greater benefit at higher LVEF values. The interaction was also significant for the primary composite when participants were divided into LVEF categories of 50% or greater, 40% to 49%, and less than 40% (P for interaction=0.021). Effect estimates favored dapagliflozin in all 3 categories, but the smaller LVEF subgroups had fewer events and wide confidence intervals.

Overall safety was comparable between dapagliflozin and control across LVEF categories, although genitourinary infections occurred more frequently with dapagliflozin. The authors said the findings support considering treatment independently of LVEF after TAVI but characterized the subgroup results as hypothesis-generating and called for confirmation in larger randomized studies with centralized LVEF assessment and longer follow-up.

Source: Raposeiras Roubín  S, Gonzalez-Manzanares R, Amat-Santos I, et al. Treatment effects of dapagliflozin in patients with aortic stenosis undergoing transcatheter aortic valve implantation across left ventricular ejection fraction. Eur J Heart Fail. Published online August 27, 2026. doi:10.1093/ejhf/xuag242