Therapeutic effects of sodium–glucose cotransporter 2 inhibitors in patients with heart failure with preserved ejection fraction: From outcome improvement to potentially favourable influences on atrial fibrillation burden, atrial fibrillation progression and atrial cardiomyopathy
Abstract
Atrial fibrillation (AF) and heart failure (HF) frequently coexist, but the link is particularly tight in HF with preserved ejection fraction (HFpEF). Taking into account the whole spectrum of HF patients, the prevalence of AF appears to be higher when HF is diagnosed in association with higher values of left ventricular ejection fraction (EF).1 Indeed, there is an important interdependence between HFpEF and AF, related to common pathophysiological pathways involving inflammation and fibrosis, leading to a frequent convergence of the two clinical manifestations.2 Sodium–glucose cotransporter 2 (SGLT2) inhibitors are a cornerstone of pharmacological treatment of both diabetes and HF,3,4 and in consideration of the mutual interrelationships2,3 there is growing interest in evaluating the clinical effects on the risk of AF and AF-related outcomes. In this issue of the Journal, Filippatos et al.5 present an interesting pre-defined secondary analysis of the EMPEROR-Preserved trial, comparing the effects of empagliflozin versus placebo on primary and secondary endpoints, as well as on safety outcomes, stratified
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