Abstract
AimsDespite substantial improvements over the last three decades, heart failure (HF) remains associated with a poor prognosis. The sodium‐glucose co‐transporter‐2 inhibitor empagliflozin demonstrated significant reductions of HF hospitalization in patients with HF independent of the presence or absence of type 2 diabetes mellitus in the EMPEROR‐Reduced trial and cardiovascular mortality in the EMPA‐REG OUTCOME trial. To further elucidate the mechanisms behind these positive outcomes, this study aims to determine the effects of empagliflozin treatment on cardiac energy metabolism and physiology using magnetic resonance spectroscopy (MRS) and cardiovascular magnetic resonance (CMR).Methods and resultsThe EMPA‐VISION trial is a double‐blind, randomized, placebo‐controlled, mechanistic study. A maximum of 86 patients with HF with reduced ejection fraction (n = 43, Cohort A) or preserved ejection fraction (n = 43, Cohort B), with or without type 2 diabetes mellitus, will be enrolled. Participants will be randomized 1:1 to receive either 10 mg of empagliflozin or placebo for 12 weeks. Eligible patients will undergo cardiovascular magnetic resonance, resting and dobutamine stress MRS, echocardiograms, cardiopulmonary exercise tests, serum metabolomics, and quality of life questionnaires at baseline and after 12 weeks. The primary endpoint will be the change in resting phosphocreatine‐to‐adenosine triphosphate ratio, as measured by 31Phosphorus‐MRS.Conclusions EMPA‐VISION is the first clinical trial assessing the effects of empagliflozin treatment on cardiac energy metabolism in human subjects in vivo. The results will shed light on the mechanistic action of empagliflozin in patients with HF and help to explain the results of the safety and efficacy outcome trials (EMPEROR‐Reduced and EMPEROR‐Preserved).
Highlights
Chronic heart failure (HF) is a progressive syndrome caused by an imbalance of oxygen supply provided by the heart and metabolic demand by various tissues
Heart failure phenotyping is based on echocardiographic measurement of left ventricular ejection fraction (LVEF) and categorizes the syndrome into two main groups: HF with reduced ejection fraction (HFrEF; LVEF < 40%) and preserved ejection fraction (HFpEF; LVEF ≥ 50%).[2]
EMPA-VISION is the first randomized trial to assess cardiac energy metabolism in patients with HFrEF and HFpEF treated with empagliflozin
Summary
Chronic heart failure (HF) is a progressive syndrome caused by an imbalance of oxygen supply provided by the heart and metabolic demand by various tissues. EMPA-VISION: a CMR study to assess empagliflozin treatment in patients with heart failure decade.[3] The global socio-economic burden of HF comprises an annual cost of $108 billion and accounts for approximately 2% of total health care expenditure.[4]. Heart failure phenotyping is based on echocardiographic measurement of left ventricular ejection fraction (LVEF) and categorizes the syndrome into two main groups: HF with reduced ejection fraction (HFrEF; LVEF < 40%) and preserved ejection fraction (HFpEF; LVEF ≥ 50%).[2] HFrEF and HFpEF have approximately equal prevalence and 5 year mortality rates.[5] HFpEF is more prevalent in older, female patients and shows a steep increase with advancing age, whereas
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
