Abstract 11301: Empagliflozin Early Reverses Metabolic and Cardiac Disturbances in Type-2 Diabetics With Chronic Heart Failure and Reduces Hospitalization for Heart Failure

IntroductionAlthough diabetes mellitus is associated with excess of worsening heart failure, effective therapies in patients with diabetes mellitus and chronic heart failure have not been established.HypothesisWe assessed hypothesis a sodium glucose co-transporter 2 inhibitor (SGLT2I), a recently developed antidiabetic agent, promptly reverses complex metabolic and cardiac disturbances in patients with type-2 diabetes mellitus and chronic heart failure.MethodsType-2 diabetic patients with chronic heart failure were randomized to group-E where they received antidiabetic therapy with empagliflozin for 2 weeks, or to group-C where they received enhanced therapies with conventional antidiabetic agents without an SGLT2I. We evaluated practical metabolic and cardiac variables including ultrasonic quantified variables. Changes in those variables from the baseline through the follow-up point were compared between the 2 groups. The cardiovascular events of the enrolled patients were prospectively followed-up.ResultsThe patients in group-E (n=28) manifested improvements in metabolic and hemodynamic variables represented by blood glucose, systolic blood pressure, body weight, hematocrit, and proBNP (pg/mL; 636.3±612.8 to 433.4±437.7, p=0.03), while those in group-C (n=14) showed no improvement except for blood glucose. The changes in body weight was characterized by those in water weight as well as those in fat weight, but not by those in muscle weight. Heart rate remained unchanged in both groups.Ultrasonocardiography showed left ventricular fractional shortening (%; 26.3±7.1 to 29.5±8.9, p=0.04), E/e’ (15.0±5.1 to 13.3±5.9, p=0.04), and respiratory variation in diameter of inferior vena cava (IVCD%; 50.2±7.2 to 64.4±8.5, p=0.03) improved in group-E, while it remained unchanged in group-C.Changes of fractional shortening, E/e’, respiratory variation in IVCD, or proBNP in group-E did not correlate to those of blood glucose (fractional shorteningr=0.10, p=0.85, E/e’r=0.19, p=0.48, respiratory variation in IVCDr=0.09, p=0.88, proBNPr=0.14, p=0.68). Hospitalization for heart failure reduced in group-E (days/year58.4±25.9 to 11.2±6.4, p=0.01), but not in group-C (55.0±28.3 to 51.2±26.2, p=0.19).ConclusionsThese results indicate empagliflozin early reduces cardiac overload and improves cardiac function independent of glucose lowering to reduce hospitalization for heart failure, which may have novel potential benefit for the patients with type-2 diabetes mellitus and chron