Effects of Dapagliflozin, Semaglutide, and Their Combination in Heart Failure Patients With Prosthetic Heart Valves (SYNCARDIA-HF)

A Prospective, Randomized, Open-Label, Blinded-Endpoint, Parallel-Group, Phase IIb Proof-of-Concept Clinical Trial of Semaglutide Added to Dapagliflozin Versus Dapagliflozin Monotherapy in Patients With Heart Failure and Previous Surgical Prosthetic Valve Replacement

This study evaluates whether adding a medication called semaglutide to an existing treatment of dapagliflozin provides better outcomes for patients with heart failure who have previously undergone surgical heart valve replacement.

Dapagliflozin is already a standard treatment for managing heart failure symptoms. However, many heart failure patients-especially those who have had surgical prosthetic valve replacements-continue to experience persistent symptoms, fluid retention, and a decline in their quality of life. This trial aims to investigate whether combining dapagliflozin with semaglutide (a medication widely used for metabolic health and weight management) can safely offer additional clinical benefits.

Participants in this study are divided into two groups:

Group 1 (Combination Therapy): Receives semaglutide added to their standard dapagliflozin routine.

Group 2 (Monotherapy Control): Continues receiving dapagliflozin alone.

Researchers will monitor both groups over a set treatment period to compare changes in heart function, symptom management, fluid control, and overall quality of life to see if the combination approach is more effective than standard treatment.

Study Overview

• Status: Completed
• Conditions: Heart Failure; Heart Valve Prosthesis
• Intervention / Treatment: Drug: semaglutide; Drug: Dapagliflozin (10mg Tab)

Detailed Description

This is a single-center, prospective, randomized, open-label, blinded-endpoint (PROBE), parallel-group, Phase IIb proof-of-concept clinical trial conducted at Kafrelsheikh University Hospital. The study evaluates the clinical efficacy, safety, and tolerability of combining the glucagon-like peptide-1 (GLP-1) receptor agonist semaglutide with the sodium-glucose cotransporter 2 (SGLT2) inhibitor dapagliflozin, compared against dapagliflozin monotherapy, in patients presenting with heart failure (HF) who have a history of surgical prosthetic heart valve replacement.

A total of 160 eligible patients are randomized in a strict 1:1 allocation ratio to one of two parallel treatment arms:

Combination Therapy Arm: Patients receive oral semaglutide escalated according to standard clinical protocol, administered in addition to a stable baseline regimen of dapagliflozin (10 mg once daily).

Monotherapy Control Arm: Patients continue to receive standard-of-care dapagliflozin monotherapy (10 mg once daily).

The primary objective is to determine if dual metabolic pathway modulation via combined SGLT2 inhibition and GLP-1 receptor agonism provides superior optimization of cardiovascular outcomes over SGLT2 inhibition alone. Key secondary and surrogate clinical outcomes assessed across the treatment duration include changes in New York Heart Association (NYHA) functional class, evaluation of fluid retention and diuretic requirements, echocardiographic parameters evaluating cardiac structure and function, and standardized quality-of-life assessment scores. Safety and tolerability profiles-including adverse event rates and systemic hemodynamic responses-will be rigorously monitored across both treatment cohorts.

• Study Type: Interventional
• Enrollment (Actual): 160
• Phase: Phase 2

Contacts and Locations

Study Locations

• Egypt
  • Kafrelsheikh Governrate
    • Kafr ash Shaykh, Kafrelsheikh Governrate, Egypt, 33511
      • Kafrelsheikh univeristy hospital, Faculty of medicine, Kafrelsheikh univeristy

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Age is at least 18 years at the time of screening.
• Confirmed diagnosis of heart failure.
• Documented history of surgical prosthetic heart valve replacement.
• Patient is currently on a stable baseline regimen of dapagliflozin (10 mg once daily).
• Patient is willing and able to provide written informed consent prior to any study-related procedures.

Exclusion Criteria:

• Known hypersensitivity or allergy to semaglutide, dapagliflozin, or any of their excipients.
• Type 1 diabetes mellitus.
• Severe renal impairment (e.g., eGFR < 25 or 30 mL/min/1.73m², depending on your exact protocol threshold) or currently requiring dialysis.
• Active pregnancy, breastfeeding, or intent to become pregnant during the 12-week study period.
• Participation in another conflicting interventional clinical trial within the past 30 days.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Combination Therapy Arm; Patients receive subcutaneous (s.c.) semaglutide escalated according to standard clinical protocol, initiated at a dose of 0.25 mg once weekly for 4 weeks, followed by a stepwise dose escalation every 4 weeks to 0.5 mg, then 1.0 mg if tolerated, administered in addition to a stable baseline regimen of dapagliflozin (10 mg once daily).	Drug: semaglutide; Subcutaneous (s.c.) semaglutide initiated at a dose of 0.25 mg once weekly for 4 weeks, followed by standard clinical titration (escalating every 4 weeks through 0.5 mg, then 1.0 mg, up to the maximum tolerated maintenance dose) for the duration of the study period.; Drug: Dapagliflozin (10mg Tab); Sodium-glucose cotransporter 2 (SGLT2) inhibitor administered orally at a stable, standard-of-care dose of 10 mg once daily.
Active Comparator: Monotherapy Control Arm; Patients continue to receive standard-of-care dapagliflozin monotherapy (10 mg once daily).	Drug: Dapagliflozin (10mg Tab); Sodium-glucose cotransporter 2 (SGLT2) inhibitor administered orally at a stable, standard-of-care dose of 10 mg once daily.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from Baseline in Left Ventricular Global Longitudinal Strain (LV-GLS) assessed by echocardiography	Left ventricular global longitudinal strain (LV-GLS) will be calculated as the average peak systolic strain using a 17-segment model derived from apical two-, three-, and four-chamber views. All studies are analyzed offline using validated software by experienced echocardiographers blinded to treatment allocation. Unit of Measure: Percentage (%), Strain is expressed as a percentage of deformation, typically a negative value where a more negative number indicates better systolic function.	Baseline and 12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change from baseline in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.	NT-proBNP is a well-established blood biomarker used to monitor myocardial wall stress and the severity of heart failure. Blood samples are drawn to measure the mean change in NT-proBNP levels (measured in pg/mL) from randomization baseline to the final follow-up.	Baseline and 12 weeks.
Change from baseline in the Kansas City Cardiomyopathy Questionnaire Clinical Summary Score (KCCQ-CSS).	The KCCQ-CSS is a patient-reported health status instrument specifically designed to measure the symptoms and physical limitations associated with heart failure. Scores range from 0 to 100, where lower scores reflect more severe symptoms/limitations and higher scores indicate better health status. This measure evaluates the efficacy of adding subcutaneous semaglutide to dapagliflozin compared to dapagliflozin alone by calculating the mean change in KCCQ-CSS from the randomization baseline to the final follow-up.	Baseline and 12 weeks.
Change from baseline in Six-Minute Walk Test (6MWT) distance.	The 6MWT evaluates objective functional capacity and exercise tolerance in heart failure patients. The test measures the maximum distance (in meters) a participant can quickly walk on a flat, hard surface in a period of 6 minutes. This endpoint calculates the mean change in walked distance from baseline to the end of the study.	Baseline and 12 weeks.
Change from Baseline in E/e' Ratio assessed by echocardiography	Calculated using transmitral Doppler peak early filling velocity (E) in cm/s and tissue Doppler early diastolic mitral annular velocity (e') in cm/s to evaluate left ventricular diastolic filling pressure.	Baseline and 12 weeks

Collaborators and Investigators

• Sponsor: Kafrelsheikh University
• Investigators: Study Chair: Reda B Bastawisy, MD (Professor), Faculty of medicine, Kafrelshiekh university; Study Chair: Mohamed K Salama, MD (Assistant professor), Faculty of medicine, Kafrelshiekh university; Study Chair: Khaled E Hamada, MD (cardiology), Faculty of medicine, Kafrelshiekh university

Study record dates

Study Major Dates

• Study Start (Actual): June 2, 2025
• Primary Completion (Actual): April 29, 2026
• Study Completion (Actual): April 29, 2026

Study Registration Dates

• First Submitted: May 20, 2026
• First Submitted That Met QC Criteria: May 20, 2026
• First Posted (Actual): May 27, 2026

Study Record Updates

• Last Update Posted (Actual): May 29, 2026
• Last Update Submitted That Met QC Criteria: May 26, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Dapagliflozin; Heart failure; Semaglutide; SGLT2 inhibitors; Valve surgery; GLP-1 receptor agonists; Prosthetic heart valve
• Additional Relevant MeSH Terms: Cardiovascular Diseases; Heart Diseases; Heart Failure; semaglutide; dapagliflozin
• Other Study ID Numbers: KFSIRB200-648

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: De-identified individual participant data (including baseline characteristics, outcome measures, and relevant clinical variables) will be made available upon reasonable request after publication of the study results.
• IPD Sharing Time Frame: Data will be available starting 6 months after publication and will remain available for up to 2 years.
• IPD Sharing Access Criteria: Access will be granted to qualified researchers upon reasonable request, subject to approval by the principal investigator and institutional ethics committee, and after signing a data sharing agreement.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL; SAP

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No