Early Efficacy of Empagliflozin in Addition to Optimal Medical Treatment of Heart Failure with Reduced Ejection Fraction

Ramos Barbosa R, Ana Luiza de A Machado, Alves Arrivabeni AC, Caniçali Simões G, Souza Gonçalves J, Tomaz de Andrade A, Rizzi Telles PH, Coelho Costa FC, Pasolini Lott L, Trevizani Neto V, Moulin Auad JP, Costa Sylvestre R, Crespo de Barros L, Machado Barbosa LF

Abstract

Introduction: Heart failure with reduced ejection fraction (HFrEF) is a life-threatening condition that can lead to unfavorable clinical outcomes. It is recommended to add a sodium-glucose cotransporter 2 (SGLT2) inhibitor to previous mortality-reducing pharmacological therapy. Full treatment access may be limited by costs in many countries, and early benefits with guideline-directed medical therapy must be proven and reinforced.

Objective: We aimed to analyze the short-term impact of empagliflozin on HFrEF patients concerning functional capacity, quality of life and left ventricle remodeling.

Methods: Prospective observational study that analyzed patients with HFrEF on triple therapy and were indicated to use SGLT2 inhibitor. A six-month follow-up was conducted for patients who adhered to empagliflozin use with no interruptions or complications. To compare the initial and final periods, patients performed the six-minute walk test (6MWT), the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and echocardiograms. The chi-square test, the Fisher’s test and the paired Student’s t-test were used for comparative analyses before and after treatment for six months, with a significance level of 0.05.

Results: Thirty patients were analyzed, mean age 61.9 ± 7.1, 30% female, 40% diabetic. The distance walked in the 6MWT raised from 372 ± 89m to 402 ± 53m (p=0.034); quality of life improved from 36.4 ± 24 points to 21.4 ± 17 points in the MLHFQ (p=0.0002); left ventricular ejection fraction raised from 30.4 ± 6% to 40.3 ± 13% (p=0.0001); left ventricular systolic diameter reduced from 49.7 ± 7mm to 45.3 ± 11mm (p=0.014). Mean left ventricular diastolic diameter was 58.7 ± 9mm at inclusion and 56.9 ± 9mm at the end of six months (p=0.29).

Conclusion: There was an improvement in functional capacity, quality of life, cardiac function and left ventricle remodeling on echocardiogram after six months of empagliflozin use added to triple therapy in HFrEF.