EMPEROR-Preserved: SGLT2 inhibitors breakthrough in the management of heart failure with preserved ejection fraction.

Kerolos Wagdy,Sherif Nagy

doi:10.21542/gcsp.2021.17

Abstract

Background: Heart failure with preserved ejection fraction (HFpEF) is a complex disease which accounts for more than half of all HF hospital admissions with high prevalence and lack of effective evidence-based management. Sodium-glucose cotransporter 2 (SGLT2) inhibitor is a new antidiabetic drug that recently gained a new role in the management of heart failure with reduced ejection fraction but its role in HFpEF had yet to be studied.Study and results: EMPEROR-Preserved trial set out to evaluate the effects of SGLT2 inhibition with empagliflozin on major heart failure outcomes in patients with HFpEF. The patients were randomized in a 1:1 fashion into two groups; to receive either empagliflozin 10 mg per day (n = 2, 997) or placebo (n = 2, 991) in addition to usual therapy. Empagliflozin led to a 21% risk reduction of the composite of cardiovascular death or hospitalization for heart failure, which was mainly related to a 29% lower risk of hospitalization for heart failure rather than effect on cardiovascular death empagliflozin. The effects SGLT2 inhibitors were consistent in all patients.What we have learnt: The EMPEROR-Preserved trial is the first randomized controlled trial testing the efficacy and safety of SGLT2 inhibitor (empagliflozin) in patients with HFpEF. The trial proves that SGLT2 inhibitors (empagliflozin) can significantly reduce HF hospitalization with neutral effect on cardiovascular (CV) death.

Highlights

Heart failure (HF) is not a single pathological diagnosis, but rather represents a wide variety of pathologies
Multiple randomized controlled trials (RCT) have been conducted with Heart failure with preserved ejection fraction (HFpEF) patients, but failed to show any significant reduction in morbidity and mortality, some improvements have been observed in some phenotypes under the umbrella of HFpEF
The DAPA-HF and EMPEROR-Reduced trials have shown a significant reduction in morbidity and mortality with Sodium-glucose cotransporter 2 (SGLT2) inhibitors (Dapagliflozin and empagliflozin) in patients with HF with reduced ejection fraction (HFrEF), regardless of DM8–10

Summary

Introduction

Heart failure (HF) is not a single pathological diagnosis, but rather represents a wide variety of pathologies. SGLT2 inhibitors have recently gained a new role in delaying and preventing heart failure in patients with type-2 diabetes mellitus (DM)[7,8]. The DAPA-HF and EMPEROR-Reduced trials have shown a significant reduction in morbidity and mortality with SGLT2 inhibitors (Dapagliflozin and empagliflozin) in patients with HFrEF, regardless of DM8–10.

Results

Conclusion