Effects of Empagliflozin on Right Ventricular Function in Heart Failure with Reduced Ejection Fraction
Abstract
OBJECTIVES: To investigate the effect of empagliflozin on right ventricular (RV) function in patients with HFrEF.
BACKGROUND: Sodium-glucose cotransporter-2 (SGLT2) inhibitors improve outcomes and reverse left ventricle (LV) remodeling in heart failure with reduced ejection fraction (HFrEF). The impact on RV function remains uncertain.
METHODS: The Empire HF trial was a randomized, double-blind trial of 190 participants with HFrEF (LVEF ≤40%) randomized (1:1) to empagliflozin (10mg/daily) or matching placebo for 12 weeks. The primary endpoint was changes in RV free wall strain (RVFWS) across the whole cohort. RVFWS was also stratified into tertiles based on baseline RVFWS. Secondary endpoints included changes in TAPSE and RV S' velocity.
RESULTS: Baseline characteristics were balanced between the groups (mean age of 64±11 years, 86% male, mean LVEF 29±8%, 79% in NYHA class II). The overall mean RVFWS was -16.7±6.1%, with the empagliflozin group at -16.4±6.2% and the placebo group at -16.9±5.9%. No differences were observed in RVFWS between the groups. When stratified by baseline RVFWS into tertiles, patients in the lowest tertile demonstrated a significant improvement with empagliflozin (treatment effect: -2.9% [95% CI: -5.0 to -0.3]; P=0.027), independent of LVEF, plasma volume, or weight loss changes. No significant treatment effect was observed in the middle or highest tertiles of RVFWS, nor in the overall or lowest tertiles of TAPSE or RV S'.
CONCLUSIONS: Empagliflozin…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 190 participants or records.
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