Right Ventricular Function and Ventricular–Arterial Coupling in HFpEF and HFmrEF treated with SGLT2 Inhibitors: A Multicenter Echocardiographic Analysis from the DISCOVER-SGLT2i Registr

We conducted a multicenter, prospective, observational study involving 13 Italian centers, enrolling patients with HFmrEF or HFpEF who had a clinical indication to start SGLT2i on top of guidelinedirected medical therapy [1]. All patients underwent comprehensive echocardiographic evaluation at baseline and after 6-months of therapy. RV function was assessed using tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), RV global longitudinal strain (RVGLS), RV free-wall longitudinal strain (RVFWLS), while V–A coupling was assessed non-invasively using the TAPSE/PASP and RVGLS/PASP[2–4]. Strain analysis reproducibility was assessed at the coordinating center in a representative sample, demonstrating intra- and inter-observer intraclass correlation coefficients >0.85 for RVGLS and RVFWLS. Patients were excluded only if baseline or 6-months echocardiography did not allow RV strain analysis, or if follow-up data for the primary endpoint were incomplete. The primary endpoint was the change in RV deformation parameters and V–A coupling over time. Baseline comparisons were descriptive only, while longitudinal analyses incorporated false discovery rate (FDR) adjustment for multiple testing.