Conclusions
obesity, HFpEF, diabetes
OBESITY, DIABETES
EMPA-VISION is the first trial to assess energetics and metabolism after treatment with empagliflozin in patients with HFrEF and HFpEF, respectively. Treatment with empagliflozin (10 mg once daily for a period of 3 months) did not lead to measurable improvements in cardiac energetics (ie, PCr/ATP) at rest or during dobutamine stress. Equally, no changes in a targeted serum metabolomic assay or levels of ketone bodies were observed in either cohort. Thus, our findings could not confirm the thrifty fuel hypothesis presumed to be responsible for the salutary effects observed with SGLT2i in HF. Further research in larger HF cohorts with distinct cardiometabolic phenotypes (eg, those with obesity and diabetes) may be required to assess potentially promising targets possibly affected by treatment with SGLT2i.