Effect of Empagliflozin on Hemodynamics in Patients With Heart Failure and Reduced Ejection Fraction
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Effect of Empagliflozin on Hemodynamics in Patients With Heart Failure and Reduced Ejection Fraction. / Omar, Massar; Jensen, Jesper; Frederiksen, Peter H.; Kistorp, Caroline; Videbæk, Lars; Poulsen, Mikael Kjær; Möller, Sören; Ali, Mulham; Gustafsson, Finn; Køber, Lars; Borlaug, Barry A.; Schou, Morten; Møller, Jacob Eifer.
I: Journal of the American College of Cardiology, Bind 76, Nr. 23, 2020, s. 2740-2751.Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › fagfællebedømt
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TY - JOUR
T1 - Effect of Empagliflozin on Hemodynamics in Patients With Heart Failure and Reduced Ejection Fraction
AU - Omar, Massar
AU - Jensen, Jesper
AU - Frederiksen, Peter H.
AU - Kistorp, Caroline
AU - Videbæk, Lars
AU - Poulsen, Mikael Kjær
AU - Möller, Sören
AU - Ali, Mulham
AU - Gustafsson, Finn
AU - Køber, Lars
AU - Borlaug, Barry A.
AU - Schou, Morten
AU - Møller, Jacob Eifer
PY - 2020
Y1 - 2020
N2 - Background: Inhibition of the sodium-glucose cotransporter-2 (SGLT2i) improves outcomes in patients with heart failure (HF) and reduced ejection fraction (HFrEF), but the mechanism by which they improve outcomes remains unclear. Objectives: This study aimed to investigate the effects of sodium-glucose cotransporter-2 inhibitor empagliflozin on central hemodynamics in patients with HF and HFrEF. Methods: This investigator-initiated, double-blinded, placebo-controlled, randomized trial enrolled 70 patients with HFrEF from March 6, 2018, to September 10, 2019. Patients were assigned to empagliflozin of 10 mg or matching placebo once daily on guideline-driven HF therapy for 12 weeks. The primary outcome was ratio of pulmonary capillary wedge pressure (PCWP) to cardiac index (CI) at peak exercise after 12 weeks. Patients underwent right-heart catheterization at rest and during exercise at baseline and 12-week follow-up. Results: Patients with HFrEF, mean age of 57 years, mean left-ventricular ejection fraction, 26%, and 12 (17%) with type 2 diabetes mellitus were randomized. There was no significant treatment effect on peak PCWP/CI (−0.13 mm Hg/l/min/m2; 95% confidence interval: −1.60 to 1.34 mm Hg/l/min/m2; p = 0.86). Considering hemodynamics over the full range of exercise loads, PCWP was significantly reduced (−2.40 mm Hg; 95% confidence interval: −3.96 to −0.84 mm Hg; p = 0.003), but not CI (−0.09 l/min/m2; 95% confidence interval: −0.14 to 0.32 l/min/m2; p = 0.448) by empagliflozin. This was consistent among patients with and without type 2 diabetes. Conclusions: Among patients with stable HFrEF, empagliflozin for 12 weeks reduced PCWP compared with placebo. There was no significant improvement in neither CI nor PCWP/CI at rest or exercise.
AB - Background: Inhibition of the sodium-glucose cotransporter-2 (SGLT2i) improves outcomes in patients with heart failure (HF) and reduced ejection fraction (HFrEF), but the mechanism by which they improve outcomes remains unclear. Objectives: This study aimed to investigate the effects of sodium-glucose cotransporter-2 inhibitor empagliflozin on central hemodynamics in patients with HF and HFrEF. Methods: This investigator-initiated, double-blinded, placebo-controlled, randomized trial enrolled 70 patients with HFrEF from March 6, 2018, to September 10, 2019. Patients were assigned to empagliflozin of 10 mg or matching placebo once daily on guideline-driven HF therapy for 12 weeks. The primary outcome was ratio of pulmonary capillary wedge pressure (PCWP) to cardiac index (CI) at peak exercise after 12 weeks. Patients underwent right-heart catheterization at rest and during exercise at baseline and 12-week follow-up. Results: Patients with HFrEF, mean age of 57 years, mean left-ventricular ejection fraction, 26%, and 12 (17%) with type 2 diabetes mellitus were randomized. There was no significant treatment effect on peak PCWP/CI (−0.13 mm Hg/l/min/m2; 95% confidence interval: −1.60 to 1.34 mm Hg/l/min/m2; p = 0.86). Considering hemodynamics over the full range of exercise loads, PCWP was significantly reduced (−2.40 mm Hg; 95% confidence interval: −3.96 to −0.84 mm Hg; p = 0.003), but not CI (−0.09 l/min/m2; 95% confidence interval: −0.14 to 0.32 l/min/m2; p = 0.448) by empagliflozin. This was consistent among patients with and without type 2 diabetes. Conclusions: Among patients with stable HFrEF, empagliflozin for 12 weeks reduced PCWP compared with placebo. There was no significant improvement in neither CI nor PCWP/CI at rest or exercise.
KW - exercise
KW - heart failure reduced ejection fraction
KW - hemodynamics
KW - SGLT2 inhibitor
U2 - 10.1016/j.jacc.2020.10.005
DO - 10.1016/j.jacc.2020.10.005
M3 - Journal article
C2 - 33272368
AN - SCOPUS:85096482653
VL - 76
SP - 2740
EP - 2751
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 23
ER -
ID: 252509175