SGLT-2 inhibitors improve cardiac function in hypertrophic cardiomyopathy: a real-world propensity score-matched study

Background and aims Hypertrophic cardiomyopathy (HCM) is characterized by left ventricular hypertrophy and diastolic dysfunction. While sodium-glucose cotransporter 2 inhibitors (SGLT-2i) have demonstrated efficacy in heart failure (HF), their role in HCM remains underexplored. This real-world study aimed to evaluate the clinical efficacy of SGLT-2i in HCM patients. Methods and results A retrospective analysis was conducted on HCM patients admitted between January 2021 and December 2024. After PSM, 94 patients initiating SGLT-2i were compared with 94 controls. Primary endpoints included changes (Δ) in echocardiographic parameters and NYHA class at 6-month follow-up. Secondary endpoint was readmission for HF by June 2025. At 6-month follow-up, patients treated with SGLT-2i showed significantly greater improvements in key parameters compared to controls: septal e ′ (Δ 0.7 ± 1.3 vs. Δ 0.04 ± 1.6 cm/s, p = 0.002), E / e ′ (Δ −5.1 ± 8.7 vs. Δ 0.4 ± 6.4, p < 0.001), and IVST (Δ −1.3 vs. Δ −0.2 mm, p = 0.005), alongside a greater reduction in NYHA class [−1 (−1 to −0.25) vs. −1 (−1 to 0), p = 0.031]. Multivariate analysis confirmed sustained differences in improvements of septal e ′ ( t = 2.26, p = 0.025), E / e ′ ( t = −3.75, p < 0.001) and NYHA class ( p = 0.038). No significant difference was found in HF readmission (20 events in SGLT-2i group vs. 17 in control group; log-rank p = 0.73) after 16.3-month median follow-up. No hypoglycemic events occurred and there was no significant deterioration in renal function. Conclusion SGLT-2i administration was associated with improved left ventricular diastolic function and NYHA class in HCM patients without increasing risks of renal dysfunction or hypoglycemia, supporting its potential therapeutic value in this population.