The impact of sodium-glucose cotransporter-2 inhibitors on left ventricular ejection fraction in patients after acute myocardial infarction and revascularization: the role of pharmacotherapy adherence

Authors

DOI:

https://doi.org/10.18413/rrpharmacology.11.816

Abstract

Introduction: Optimal recovery of left ventricular ejection fraction (LVEF) in chronic heart failure (CHF) patients after acute myocardial infarction (AMI) is challenging in real-world settings, where therapy adherence varies. Aim: This study assessed the comparative effectiveness of revascularization, neurohumoral modulator (NHM) therapy, and sodium-glucose cotransporter-2 inhibitors (SGLT2i) on LVEF dynamics, considering actual adherence.

Materials and Methods: A retrospective, population-based study used electronic medical records from the Electronic medical information and analytical system (2021–2023). 107 patients with AMI and CHF (NYHA I–III) receiving free outpatient care were included. Adherence was measured by Proportion of Days Covered (PDC). LVEF was evaluated at baseline, 6, and 12 months. Effect size was estimated using Hedges’ g.

Results: Revascularization alone led to moderate LVEF improvement (+3.43% at 12 months, g=0.49). High NHM adherence (PDC ≥80%) was associated with greater LVEF gains (+6.70% vs. +3.43%, p=0.034). Only 24.3% maintained optimal adherence. Adding SGLT2i resulted in the largest improvement (+8.55% at 12 months, g=1.06), with 70% achieving LVEF ≥45%. Maximal SGLT2i effects were seen in patients with severe baseline impairment.

Conclusions: Maximal myocardial recovery after AMI requires successful revascularization, high NHM adherence, and early SGLT2i initiation. Suboptimal adherence significantly reduces efficacy. These findings highlight the need for adherence-support programs and wider SGLT2i use to optimize outcomes in CHF patients.

Graphical Abstract

Keywords:

heart failure, left ventricular ejection fraction, medication adherence, myocardial infarction, myocardial revascularization, neurohormonal modulating therapy, proportion of days covered (PDC), real-world clinical data, SGLT-2 inhibitors

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Author Contribution

Sergey B. Fitilev, Peoples’ Friendship University of Russia named after Patrice Lumumba

Doctor Habilitated of Medical Sciences, Professor; Professor of the Department of Pharmacology and Clinical Pharmacology, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba; Clinical pharmacologist, City Polyclinic No 2 of Moscow Healthcare Department, Moscow, Russia; e-mail: fitilev-sb@rudn.ru; ORCID ID: https://orcid.org/0000-0001-8395-419X. The author contributed to the concept and design of the study, investigation, data analysis, validation, and drafting of the manuscript and translated the final version of the article into English.

Irina I. Shkrebniova, Peoples’ Friendship University of Russia named after Patrice Lumumba

Candidate of Medical Science, Associate Professor; Associate Professor of the Department of Pharmacology and Clinical Pharmacology, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba; Clinical pharmacologist, City Polyclinic No 2 of Moscow Healthcare Department, Moscow, Russia; e-mail: shkrebneva-ii@rudn.ru; ORCID ID: https://orcid.org/0000-0002-0070-3115. The author contributed to study concept, investigation, data analysis, and the review of the manuscript and translated the final version of the article into English.

Dmitry A. A. Klyuev, Peoples’ Friendship University of Russia named after Patrice Lumumba

Candidate of Pharmaceutical Sciences; Assistant Professor of the Department of Pharmacology and Clinical Pharmacology, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia; e-mail: kliuev-da@rudn.ru; ORCID ID: https://orcid.org/0000-0003-2400-3938. The author provided resources and participated in the review of the manuscript.

Mikhail I. Smirnov, Peoples’ Friendship University of Russia named after Patrice Lumumba

Ppost-graduate student at the Department of Pharmacology and Clinical Pharmacology, Medical Institute, Peoples’ Friendship University of Russia named after Patrice Lumumba, Moscow, Russia; e-mail: michail@yandex.ru; ORCID ID: https://orcid.org/0009-0006-6428-1368. The author contributed to data gathering, provided resources, and participated in the review of the manuscript.

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Published

29-12-2025

How to Cite

Fitilev SB, Shkrebniova II, A. Klyuev DA, Smirnov MI (2025) The impact of sodium-glucose cotransporter-2 inhibitors on left ventricular ejection fraction in patients after acute myocardial infarction and revascularization: the role of pharmacotherapy adherence. Research Results in Pharmacology 11(4): 235–245. https://doi.org/10.18413/rrpharmacology.11.816

Issue

Vol. 11 No. 4 (2025)

Section

Clinical Pharmacology

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Copyright (c) 2025 Fitilev SB, Shkrebniova II, Klyuev DA, Smirnov MI

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