Empagliflozin does not change cardiac index nor systemic vascular resistance but rapidly improves left ventricular filling pressure in patients with type 2 diabetes: a randomized controlled study

Abstract Background In the EMPA-REG OUTCOME trial (Empagliflozin Cardiovascular Outcome Event Trial) treatment with sodium-glucose cotransporter-2 (SGLT2) inhibitor empagliflozin significantly reduced heart failure hospitalization (HHF) in patients type 2 diabetes mellitus (T2D) and established cardiovascular disease. The early separation of HHF event curves within first 3 months suggest that immediate hemodynamic effects may play a role. However, hitherto no data exist on SGLT2 inhibitors parameters cardiac function. Thus, this study examined delayed including systemic vascular resistance index, stroke volume as well echocardiographic measures Methods placebo-controlled, randomized, double blind, exploratory T2D were randomized to 10 mg or placebo for period months. Hemodynamic assessed after 1 day, days treatment. Results Baseline characteristics not different (n = 22) 20) group. Empagliflozin led significant increase urinary glucose excretion (baseline: 7.3 ± 22.7 g/24 h; day 1: 48.4 34.7 p < 0.001) (1740 601 mL/24 h 2112 837 0.011) already one compared placebo. Treatment had effect primary endpoint nor index pulse rate at any time point. addition, echocardiography showed difference left ventricular systolic function by ejections fraction strain analysis. improved filling pressure reduction mitral inflow velocity relative diastolic relaxation (E/e?) which became 9.2 2.6; 8.5 2.2; 0.005) remained apparent throughout study. This was primarily attributable E 0.8 0.2 m/s; 0.73 m/sec; 0.003). Conclusions has days, months, but leads rapid sustained improvement Trial registration EudraCT Number: 2016-000172-19; date registration: 2017-02-20 (clinicaltrialregister.eu)