2023-05-09 21:34:14
Why is this important?
iSGLT2 is a reference treatment in heart failure with reduced (ICFEr, LVEF≥50%) or preserved (ICFEp) ejection fraction, but the underlying mechanism is not clearly identified. Since the effect of treatment on blood pressure alone cannot explain the improvement in cardiac prognosis, the identification of other mechanisms is under study. It has been hypothesized that the decrease in glucose utilization and the parallel increase in lipid mobilization leads to moderate hyperketonemia leading to the preferential use of beta-hydroxybutyrate by the heart and, in fact, an improvement in functioning. cardiomyocytes. This prospective, randomized, double-blind study aimed to verify the basis of this energy saving hypothesis by studying cardiac metabolism.
Methodology
EMPA-VISION included 2 cohorts of ICFEr and ICFEp patients, respectively, whose severity was between NYHA classes II-IV. Patients were randomized between empagliflozin 10mg and placebo for 12 weeks. As part of this study, several exploratory measures were defined and evaluated during the study, and mass spectrometry was conducted around 19 metabolites. The energy metabolism at rest and after a stress test with dobutamine, and the phosphocreatine/ATP ratio were measured in particular, as well as blood biomarkers relating to the effects of the drug on metabolism or on neurohormonal activation.
Principle results
A total of 72 patients were recruited, equally distributed between the two ICFEr and ICFE cohorts, and between empagliflozin and placebo (mean age 64-72 years, 50-68.4% male, NYHA class II for 70 .6 to 94.7%).
After 12 weeks, no significant difference was observed in the phosphocreatine/ATP ratio at rest in the two cohorts, between those on empagliflozin and those on placebo. Similarly, no significant difference in the measurements was observed after the stress test under dobutamine.
Furthermore, no difference between the empagliflozin and placebo arms was observed concerning the determination of myocardial triglycerides by magnetic resonance spectroscopy.
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#Heart #failure #mechanisms #benefit #empagliflozin