What Are the Clinical Implications?
Heart Failure, HFpEF, HF, glucosuria, multiorgan syndrome, caloric deficit, Heart failure, heart failure
HEART FAILURE, HEART FAILURE, HEART FAILURE
SGLT2 inhibition with empagliflozin (10 mg once daily) for 3 months did not improve cardiac energetics in patients with heart failure with reduced ejection fraction or heart failure with preserved ejection fraction.Thus, the proposed “thrifty fuel hypothesis,” suggesting improved energy provision to be a central mechanism underlying the SGLT2i beneficial clinical effects observed in patients with heart failure, could not be confirmed.Our study suggests that effects other than enhanced energy metabolism may explain the favorable effects of empagliflozin observed in patients with heart failure.Heart failure (HF), a clinically complex multiorgan syndrome, has a plethora of possible causes, and despite multiple treatment innovations, overall prognosis remains poor.After their serendipitous discovery as novel heart failure drugs,SGLT2i induce glucosuria and, thus, lead to a caloric deficit of approximately 250 calories per day.Irrespective of the underlying etiology, HF displays a reduction in myocardial energy provision, affecting all components of the energetic system.No previous study has investigated the metabolic effects of SGLT2i in patients with HFrEF or HFpEF in vivo. Accordingly, EMPA-VISION (Assessment of Cardiac Energy Metabolism, Function and Physiology in Patients With Heart Failure Taking Empagliflozin) is the first prospective, randomized, double-blind, placebo-controlled trial assessing the effects of empagliflozin treatment on cardiac energetics and physiology.