Effect of Empagliflozin on Hemodynamics in Patients With Heart Failure and Reduced Ejection Fraction

Massar Omar, Jesper Jensen, Peter H. Frederiksen, Caroline Kistorp, Lars Videbæk, Mikael Kjær Poulsen, Sören Möller, Mulham Ali, Finn Gustafsson, Lars Køber, Barry A. Borlaug, Morten Schou, Jacob Eifer Møller

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2740-2751
Number of pages12
JournalJournal of the American College of Cardiology
Volume76
Issue number23
DOIs
StatePublished - Dec 8 2020

Keywords

  • SGLT2 inhibitor
  • exercise
  • heart failure reduced ejection fraction
  • hemodynamics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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