Limitations
HFpEF
TYPE 2 DIABETES
Despite using gold-standard CMR techniques and assessing cardiac as well as whole-body metabolism, our study has several possible limitations. As this is a mechanistic trial, the relatively small sample size, lower-than-anticipated number of patients with type 2 diabetes, and limited ethnic variety in our study may limit the generalizability and comparability of our findings. Patients were only recruited from a single center and investigated twice (before and after treatment). Due to the technical characteristics of our investigation for the primary end point (ie, PCr/ATP), our study is limited to a nonischemic etiology of HF.We assessed a limited treatment interval of 3 months using a single SGLT2i with one strength (10 mg of empagliflozin); it is unknown whether longer treatment periods, a different SGLT2i, or a higher dose may have led to dissimilar results. Finally, 13 patients (18.1 %) in our HFpEF cohort were excluded from the PPS because of COVID-19 lockdown restrictions. which may have limited the efficacy findings in this cohort.