Interaction of natriuretic peptide levels and ejection fraction on outcomes with dapagliflozin and empagliflozin in heart failure
Abstract
Sodium–glucose cotransporter 2 inhibitors improve outcomes in patients with heart failure (HF). The EMPEROR-Reduced (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Reduced Ejection Fraction) and DAPA-HF (Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure) trials showed that empagliflozin and dapagliflozin reduced the risk of cardiovascular death or hospitalizations for HF (HHF) in patients with HF with reduced ejection fraction (HFrEF).1 Subsequently, the EMPEROR-Preserved (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure With Preserved Ejection Fraction) and DELIVER (Dapagliflozin Evaluation to Improve the LIVEs of Patients with Preserved Ejection Fraction Heart Failure) trials showed similar findings in patients with HF with preserved ejection fraction (HFpEF).1 The overall results were comparable across these trials, but cardiovascular mortality was nominally significantly reduced in DAPA-HF but not in EMPEROR-Reduced. These two trials were different in their inclusion criteria with respect to N-terminal pro B-type natriuretic peptide (NT-proBNP) levels. To enhance event rates in patients without severely reduced ejection fractions, EMPEROR-Reduced required a higher level in those with left ventricular ejection fraction (LVEF) between 31% and 40% (NT-proBNP criteria for LVEF ≤30%: ≥600 and ≥1200 pg/ml; LVEF ≥31% to 35%: ≥1000 and ≥2000 pg/ml; and LVEF 36–40%: ≥2500 pg/ml or ≥5000 pg/ml for patients without and with…
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