Empagliflozin reduces left ventricular volumes in patients with HFrEF

  • Lee MMY & al.
  • Circulation
  • 13 Nov 2020

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Treatment with sodium-glucose cotransporter 2 (SGLT2) inhibitor empagliflozin led to significant reductions in left ventricular (LV) volumes (LV end-systolic volume index [LVESVi] and LV end-diastolic volume index [LVEDVi]), as well as reductions in N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with heart failure with reduced ejection fraction (HFrEF) and type 2 diabetes (T2D) or prediabetes.
  • However, no improvement was seen in LV global longitudinal strain (LV GLS).

Why this matters

  • Findings suggest that favourable reverse LV remodeling may be a mechanism by which SGLT2 inhibitor empagliflozin reduces HF hospitalisation and mortality in HFrEF.

Study design

  • In this SUGAR-DM-HF trial, 105 patients with HFrEF and T2D or prediabetes were randomly assigned (1:1) to receive empagliflozin or placebo.
  • Co-primary outcomes: change in LVESVi and LV GLS from baseline to 36 weeks measured using cardiovascular magnetic resonance (CMR).
  • Funding: Boehringer Ingelheim.

Key results

  • 82 patients (78.1%) had diabetes and 23 (21.9%) had prediabetes; mean LV ejection fraction was 32.5%.
  • Empagliflozin vs placebo group had a significant reduction in:
    • LVESVi (adjusted between-group difference, −6.0 mL/m2; 95% CI, −10.8 to −1.2; P=.015);
    • LVEDVi (adjusted between-group difference, −8.2 mL/m2; 95% CI, −13.7 to −2.6; P=.004); and
    • NT-proBNP (adjusted between-group difference, −28%; 95% CI, −47 to −2%; P=.038).
  • No difference in LV GLS was seen between the empagliflozin and placebo groups (adjusted between-group difference, 0.35; 95% CI, −0.25 to 0.95; P=.25).
  • No between-group differences were seen in:
    • other CMR measures;
    • Kansas City Cardiomyopathy Questionnaire Total Symptom Score;
    • 6-minute walk distance; and
    • B-lines on lung ultrasound and biomarkers (including NT-proBNP).


  • Patients with atrial fibrillation or cardiac devices were not included to avoid image degradation.