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Drs Piña and Borlaug discuss the CMR substudy from the SUMMIT trial of tirzepatide in HFpEF/obesity. How does weight loss affect pericardial fat and skeletal muscle? https://www.medscape.com/viewarticle/how-do-glp-1s-affect-cardiac-structure-and-skeletal-muscle-2025a10001qm?src=soc_yt --TRANSCRIPT-- Ileana L. Piña, MD, MPH: Hello. I’m Ileana Piña, from Thomas Jefferson University in Philadelphia, Pennsylvania, and this is my blog. It’s a little bit different blog because I’m really interviewing a good friend about these glucagon-like peptide 1 (GLP-1) inhibitors. Some of our heart failure patients are getting their GLP-1 inhibitors from their primary care physicians, but many questions have arisen with the trial called SUMMIT. With us today is Barry Borlaug, who is in charge of the research section with the cardiovascular section of Mayo, and that is Mayo, Rochester, where it must be much colder even than here in Philadelphia. Barry, congratulations on that trial. Tell our audience a little bit about how the trial was structured because it’s important how we get into your information. SUMMIT Recap Barry A. Borlaug, MD: Thanks, Ileana. SUMMIT was a randomized, double-blind, placebo-controlled trial, testing the GLP-1/glucose-dependent insulinotropic polypeptide (GIP) agonist tirzepatide vs placebo in patients with heart failure with preserved ejection fraction (HFpEF). Unlike some other trials, this was real HFpEF with an ejection fraction of 50% or above. Patients were randomized 1:1 to tirzepatide, titrated up to 15 mg once weekly, or placebo and treated for a minimum of 52 weeks. The dual primary endpoints were worsening heart failure or cardiovascular death and quality of life by the Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical summary score. The median duration of follow-up was 2 years. We continued follow-up until the last patient enrolled completed the full 52-week period of treatment. We found that, as compared to placebo, tirzepatide reduced the risk of worsening heart failure or cardiovascular death by 38%, which was statistically significant, and also improved the KCCQ clinical summary score. In addition to that, we also looked at other patient-centered outcomes like 6-minute walk distance and biochemical markers like C-reactive protein (CRP). We saw that there was also a significant improvement in exercise function measured by 6-minute walk distance and about a 40% decrease in CRP levels. Piña: How long did the total trial last, including the time that the drugs were being administered? Borlaug: The longest duration of follow-up was 3 years, and the median follow-up was 2 years. Piña: Were any of these patients also on sodium-glucose cotransporter 2 ( SGLT2) inhibitors ? Borlaug: Yeah, a minority of patients were also on SGLT2 inhibitors, about 17%. Piña: What was the baseline KCCQ score? Borlaug: Very poor. A s you know, physician-reported heart failure severity often doesn’t agree with patient reports. Overall, 72% of the patients were judged by their physicians to have class II heart failure, but the mean KCCQ score was just over 53, so pretty severe patient-reported limitations or severe HFpEF. Despite this — and this is often the case in HFpEF and obesity-related HFpEF — the median N-terminal pro-B-type natriuretic peptide ( NT-proBNP) was only 175. Piña: I was very surprised at that. Very surprised. That really is low. That was NT-proBNP. That wasn’t BNP. Transcript in its entirety can be found by clicking here: https://www.medscape.com/viewarticle/how-do-glp-1s-affect-cardiac-structure-and-skeletal-muscle-2025a10001qm?src=soc_yt

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