SGLT-2 inhibitor therapy improved ventricular-arterial coupling (VAC) in patients with heart failure with reduced ejection fraction (HFrEF). Findings were presented at the European Society of Cardiology (ESC) Congress 2025.

The study enrolled 460 symptomatic HFrEF patients (NYHA class II or higher, LVEF <40%) in a multicenter prospective observational study. Patients received optimized guideline-directed therapy plus SGLT-2i. Clinical, laboratory, and echocardiographic data were collected at baseline, 6–12 months, and 18 months. VAC was measured non-invasively using the ratio of arterial elastance to ventricular elastance.

VAC improved significantly during follow-up (2.35 ± 0.87 to 1.82 ± 1.29, p<0.001), with benefits already evident at six months. Improvement correlated with N-terminal pro–B-type natriuretic peptide (NT-proBNP) reduction (r=-0.343, p=0.0002) and LVEF increase (r=-0.893, p<0.001). Patients achieving ≥10% VAC improvement (n=277) experienced fewer adverse events than those with <10% improvement (23.5% vs 41.5%, p=0.0001).

SGLT-2i therapy enhances VAC and improves prognosis in HFrEF. VAC measurement offers a simple, low-cost tool to monitor therapy response and may serve as a new therapeutic target.