{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T07:11:07Z","timestamp":1790838667315,"version":"4.1.0"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":212,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,7,21]],"date-time":"2025-07-21T00:00:00Z","timestamp":1753056000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Dapagliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, has shown clinical benefits in adults with heart failure (HF), improving cardiac function, reducing HF-related hospitalizations and enhancing survival rates. While extensively studied in adult HF, data on its efficacy and safety in paediatric HF patients remain limited. We aimed to evaluate the use of dapagliflozin in addition to optimized therapy in paediatric HF patients regarding safety, clinical outcomes and adverse events.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a single-centre retrospective analysis of 37 paediatric HF patients (median age 9.0 years, range 0.2\u201317.1 years) treated with dapagliflozin at our institution between April 2022 and February 2025. Clinical outcomes, left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), NT-proBNP levels and estimated glomerular filtration rate (eGFR) were analysed at baseline, 3\u20136 months and the latest follow-up. The most frequent diagnoses among paediatric HF patients treated with dapagliflozin were dilated cardiomyopathy (43.2%, 56% of those with acute myocarditis), heart transplant recipients (18.9%) and single ventricle heart defects (16.2%). The median duration of dapagliflozin treatment was 189 days (Q1, Q3: 381, 596). Dapagliflozin was well tolerated, with no severe adverse effects observed. During follow-up, four patients required ventricular assist device (VAD) implantation, five underwent heart transplantation and one patient died. In six patients, the VAD could be explanted due to myocardial recovery. Overall, LVEF significantly improved from 40% at baseline to 51% at 3\u20136 months and further to 57% at latest follow-up (P = 0.016). GLS significantly improved from \u22129.2% to \u221214.7% from baseline to latest follow-up (P = 0.023). Heart failure classification significantly improved from baseline to latest follow-up (P = 0.004). NT-proBNP levels decreased during follow-up, without reaching statistical significance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Dapagliflozin in addition to optimized HF therapy was safe and well tolerated in paediatric HF patients, with improvements in functional class, left ventricular contractility and heart failure symptoms. The study's limitations, including its small sample size and retrospective design, highlight the need for larger, multicentre, prospective trials to confirm these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.15386","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T06:25:36Z","timestamp":1753165536000},"page":"3494-3501","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Initial Clinical Experience with Dapagliflozin in Addition to Optimized Medical Therapy in Paediatric Heart Failure Patients"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4083-1186","authenticated-orcid":false,"given":"Lisa-Maria","family":"Rosenthal","sequence":"first","affiliation":[{"name":"Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin ,","place":["Germany"]},{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t and Humboldt-Universit\u00e4t zu Berlin , Berlin ,","place":["Germany"]},{"name":"Berlin Institute of Health , Berlin ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research, Partner Site Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Miera","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin ,","place":["Germany"]},{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t and Humboldt-Universit\u00e4t zu Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annemarie","family":"Krauss","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin ,","place":["Germany"]},{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t and Humboldt-Universit\u00e4t zu Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Friederike","family":"Danne","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin ,","place":["Germany"]},{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t and Humboldt-Universit\u00e4t zu Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Berger","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin ,","place":["Germany"]},{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t and Humboldt-Universit\u00e4t zu Berlin , Berlin ,","place":["Germany"]},{"name":"German Centre for Cardiovascular Research, Partner Site Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kramer","sequence":"additional","affiliation":[{"name":"Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charit\u00e9 (DHZC) , Berlin ,","place":["Germany"]},{"name":"Charit\u00e9 Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t and Humboldt-Universit\u00e4t zu Berlin , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,21]]},"reference":[{"key":"2026021804214115000_ehf215386-bib-0001","doi-asserted-by":"publisher","first-page":"1032","DOI":"10.1136\/heartjnl-2020-318060","article-title":"Sodium-glucose co-transporter 2 inhibitor therapy: mechanisms of action in heart failure","volume":"107","author":"Joshi","year":"2021","journal-title":"Heart"},{"key":"2026021804214115000_ehf215386-bib-0002","doi-asserted-by":"publisher","first-page":"632","DOI":"10.1016\/j.jacbts.2020.02.004","article-title":"Mechanisms of cardiovascular benefits of sodium glucose co-transporter 2 (SGLT2) inhibitors: a state-of-the-art review","volume":"5","author":"Lopaschuk","year":"2020","journal-title":"JACC Basic Transl Sci"},{"key":"2026021804214115000_ehf215386-bib-0003","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1056\/NEJMoa2022190","article-title":"Cardiovascular and renal outcomes with empagliflozin in heart failure","volume":"383","author":"Packer","year":"2020","journal-title":"N Engl J Med"},{"key":"2026021804214115000_ehf215386-bib-0004","doi-asserted-by":"publisher","first-page":"1995","DOI":"10.1056\/NEJMoa1911303","article-title":"Dapagliflozin in patients with heart failure and reduced ejection fraction","volume":"381","author":"McMurray","year":"2019","journal-title":"N Engl J Med"},{"key":"2026021804214115000_ehf215386-bib-0005","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1016\/S0140-6736(22)01429-5","article-title":"SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials","volume":"400","author":"Vaduganathan","year":"2022","journal-title":"Lancet"},{"key":"2026021804214115000_ehf215386-bib-0006","doi-asserted-by":"publisher","first-page":"2512","DOI":"10.1038\/s41591-022-02041-5","article-title":"Efficacy of empagliflozin in heart failure with preserved versus mid-range ejection fraction: a pre-specified analysis of EMPEROR-preserved","volume":"28","author":"Anker","year":"2022","journal-title":"Nat Med"},{"key":"2026021804214115000_ehf215386-bib-0007","doi-asserted-by":"publisher","first-page":"1089","DOI":"10.1056\/NEJMoa2206286","article-title":"Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction","volume":"387","author":"Solomon","year":"2022","journal-title":"N Engl J Med"},{"key":"2026021804214115000_ehf215386-bib-0008","doi-asserted-by":"publisher","first-page":"1956","DOI":"10.1038\/s41591-022-01971-4","article-title":"Dapagliflozin across the range of ejection fraction in patients with heart failure: a patient-level, pooled meta-analysis of DAPA-HF and DELIVER","volume":"28","author":"Jhund","year":"2022","journal-title":"Nat Med"},{"key":"2026021804214115000_ehf215386-bib-0009","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1056\/NEJMoa2030183","article-title":"Sotagliflozin in patients with diabetes and recent worsening heart failure","volume":"384","author":"Bhatt","year":"2021","journal-title":"N Engl J Med"},{"key":"2026021804214115000_ehf215386-bib-0010","doi-asserted-by":"publisher","first-page":"1954","DOI":"10.1038\/s41591-021-01536-x","article-title":"The SGLT2 inhibitor dapagliflozin in heart failure with preserved ejection fraction: a multicenter randomized trial","volume":"27","author":"Nassif","year":"2021","journal-title":"Nat Med"},{"key":"2026021804214115000_ehf215386-bib-0011","doi-asserted-by":"publisher","first-page":"1403","DOI":"10.1016\/j.jacc.2024.02.017","article-title":"Effect of sodium-glucose cotransporter 2 inhibitors in adults with congenital heart disease","volume":"83","author":"Neijenhuis","year":"2024","journal-title":"J Am Coll Cardiol"},{"key":"2026021804214115000_ehf215386-bib-0012","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1007\/s00246-022-02983-0","article-title":"Early clinical experience with dapagliflozin in children with heart failure","volume":"44","author":"Newland","year":"2023","journal-title":"Pediatr Cardiol"},{"key":"2026021804214115000_ehf215386-bib-0013","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1038\/ki.2012.169","article-title":"Improved equations estimating GFR in children with chronic kidney disease using an immunonephelometric determination of cystatin C","volume":"82","author":"Schwartz","year":"2012","journal-title":"Kidney Int"},{"key":"2026021804214115000_ehf215386-bib-0014","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1515\/cclm-2019-1185","article-title":"Continuous, complete and comparable NT-proBNP reference ranges in healthy children","volume":"58","author":"Palm","year":"2020","journal-title":"Clin Chem Lab Med"},{"key":"2026021804214115000_ehf215386-bib-0015","doi-asserted-by":"publisher","first-page":"1890","DOI":"10.1016\/j.jacc.2021.08.056","article-title":"Predicting major adverse cardiovascular events in children with age-adjusted NT-proBNP","volume":"78","author":"Palm","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"2026021804214115000_ehf215386-bib-0016","doi-asserted-by":"publisher","first-page":"888","DOI":"10.1016\/j.healun.2014.06.002","article-title":"The International Society for Heart and Lung Transplantation guidelines for the management of pediatric heart failure: executive summary","volume":"33","author":"Kirk","year":"2014","journal-title":"J Heart Lung Transplant"},{"key":"2026021804214115000_ehf215386-bib-0017","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1007\/s00246-023-03332-5","article-title":"Experience with SGLT2 inhibitors in patients with single ventricle congenital heart disease and Fontan circulatory failure","volume":"46","author":"Konduri","year":"2023","journal-title":"Pediatr Cardiol"},{"key":"2026021804214115000_ehf215386-bib-0018","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-024-03604-8","article-title":"Dapagliflozin use in children with advanced heart failure undergoing heart transplantation: a matched case-control study","author":"Newland","year":"2024","journal-title":"Pediatr Cardiol"}],"container-title":["ESC Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/12\/5\/3494\/66969771\/eschf_12_5_3494.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eschf\/article-pdf\/12\/5\/3494\/66969771\/eschf_12_5_3494.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T09:21:47Z","timestamp":1771406507000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eschf\/article\/12\/5\/3494\/8488261"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,21]]},"references-count":18,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,7,21]]},"published-print":{"date-parts":[[2025,10,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ehf2.15386","relation":{},"ISSN":["2055-5822"],"issn-type":[{"value":"2055-5822","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,10]]},"published":{"date-parts":[[2025,7,21]]},"assertion":[{"value":"2025-03-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}