Effect of empagliflozin on left ventricular contractility and peak oxygen uptake in subjects with type 2 diabetes without heart disease: results of the EMPA-HEART trial

• DOI: 10.1186/s12933-022-01618-1
• Publication Date: 2022-09-12T17:03:17Z
• Authors: Lorenzo Nesti; Nicola Riccardo P...; Paolo Sciuto; Domenico Trico; Angela Dardano; Simona Baldi; Silvia Pinnola; Iacopo Fabiani; Vitantonio Di Bello; Andrea Natali
• Keywords: Empagliflozin; Contractility

The mechanism through which sodium-glucose cotransporter 2 inhibitors (SGLT2i) prevent the incidence of heart failure and/or affect cardiac structure and function remains unclear.The EMPA-HEART trial is aimed at verifying whether empagliflozin improves myocardial contractility (left ventricle global longitudinal strain, LV-GLS) cardiopulmonary fitness (peak oxygen uptake, VO2peak) in subjects with type diabetes (T2D) without disease. Patients T2D, normal LV systolic (2D-Echo EF > 50%), no disease were randomized to either 10 mg or sitagliptin 100 for 6 months underwent repeated exercise tests echocardiography determination plasma biomarkers.Forty-four patients completed study, 22 per arm. Despite comparable glycaemic control, modest reductions body weight (- 1.6; [- 2.7/- 0.5] kg, p = 0.03) uric acid 1.5; 2.3/- 0.6], 0.002), as well an increase haemoglobin (+ 0.7; [+ 0.2/+ 1.1] g/dL, 0.0003) evident empagliflozin. No difference was detectable LV-GLS 1 month (empagliflozin vs sitagliptin: + 0.44; 0.10/+ 0.98]%, 0.11) therapy 0.53; 0.56/+ 1.62]%), VO2peak 0.43; 1.4/+ 2.3] mL/min/kg, 0.65). With empagliflozin, subgroup baseline below median experienced a greater (time*drug < 0.05) 1.22; 0.31/+ 2.13]%) 2.05; 1.14/+ 2.96]%), while induced improvement only 0.92; 0.21/+ 0.62]%).Empagliflozin has neutral impact on both tolerance T2D left ventricular function. However, subclinical dysfunction (LV-GLS 16.5%) it produces rapid sustained amelioration contractility. Trial registration EUDRACT Code 2016-002225-10.