Empagliflozin LV remodeling not reliant on glucose lowering
medwireNews: The EMPATROPISM trial, which enrolled people without type 2 diabetes, shows reversal of left ventricular (LV) remodeling in patients with heart failure and reduced ejection fraction (HFrEF) given empagliflozin rather than placebo.
Between baseline and 6 months the primary endpoint of LV end-diastolic volume decreased by significantly more in the 42 participants randomly assigned to take the sodium-glucose cotransporter (SGLT)2 inhibitor empagliflozin than in the 42 taking placebo, at 25.1 versus 1.5 mL. And the same was true for end-systolic volume, at 26.6 versus 0.5 mL.
Empagliflozin treatment also resulted in a significant reduction in LV mass, at 17.8 g versus a 4.1 g increase with placebo, as well as a significant reduction in LV sphericity and increase in ejection fraction.
This in turn benefitted the study participants’ functional capacity, with empagliflozin treatment associated with significant improvements in maximal exercise capacity and 6-minute walk distance, which the researchers stress is of “utmost importance.”
The trial participants all had stable New York Heart Association class II–III HF, with an average LV ejection fraction of 36%. A large proportion were from ethnic minorities (50% Latinos and 19% African Americans) and none had diabetes.
“The mechanism(s) of the cardiac benefits of SGLT2 [inhibitors] remain incompletely understood,” write Juan Badimon (Icahn School of Medicine at Mount Sinai, New York, USA) and co-researchers in the Journal of the American College of Cardiology.
But they add that their study in patients with HF but without type 2 diabetes underlines that some of the cardiac benefits of SGLT2 inhibitors are independent of their glucose-lowering ability.
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