Short-Term Effects of a Sodium-Glucose Linked Transporter 2 Inhibitor on Left Ventricular Relaxation in Nondiabetic Hypertensive Patients

Abstract

Background: The rapid beneficial effects of Empagliflozin on cardiovascular mortality and hospitalization rate for heart failure in subjects with type 2 diabetes Mellitus raised some questions related to a potential intrinsic effect on the heart. We conducted this study in a population of nondiabetic hypertensive patients in order to look out for short-term effects on left ventricular relaxation. Methods: We carried out a single arm non-randomized clinical trial. Each patient received 25mg of empagliflozin as add-on therapy once daily for six weeks. We included nondiabetic hypertensive patients on stable anti-hypertensive medication for at least 12weeks with diastolic dysfunction haven given their informed consent. The outcome measures were to evaluate the left ventricular relaxation, to determine changes in the nycthemeral blood pressure profile and to evaluate the electrocardiographic profile before and after the treatment. The primary endpoint was the increase in velocity of the lateral mitral annulus e’ at Doppler echocardiography. Results: A total of 11 patients were treated. Nine patients had significant improvement of their mitral profiles E/A from 0.71 [0.58-0.75] to 0.82 [0.79-0.93] cm/s (p= 0.008). The velocity e’ that was impaired in 5 patients improved by 22% in 4 patients. The effect of empagliflozin was non-significant on blood pressure at ABPM. On the electrocardiogram we observed a significant decrease in the PR interval from 200 [157-200] to 160 [143-186] ms, p= 0.04. Conclusion: Daily intake of 25mg Empagliflozin is associated with an early improvement of the left ventricular relaxation in nondiabetic hypertensive patients without significant reduction in blood pressure. This suggests an intrinsic myocardial action of Empagliflozin to investigate. Disclosure E. Krystel Kelly: None. J. Mbanya: Advisory Panel; Self; GlaxoSmithKline plc.. Speaker's Bureau; Self; Novo Nordisk A/S, Sanofi, Servier. E. Sobngwi: None. M. Liliane: None.