Randomized Trial of Empagliflozin in Nondiabetic Patients With Heart Failure and Reduced Ejection Fraction

Association of sodium‐glucose cotransporter‐2 inhibitors with outcomes in type 2 diabetes with reduced and preserved left ventricular ejection fraction: Analysis from the CVD‐REAL 2 study

“…Our findings from real‐world clinical practice demonstrate lower risk of HHF and death associated with the use of SGLT2 inhibitors versus OGLDs that is consistent in T2D patients with both reduced and preserved EF, and suggest that the HHF and mortality benefits of SGLT2 inhibitors may extend across the range of baseline EF. These results are consistent with recent HFrEF clinical trials in patients with and without diabetes, 3,4,8 including evidence of improvement in LV structure and function with SGLT2 inhibitors independent of diabetes 8 . Our results further suggest that the benefit may extend to HFpEF, at least in patients with diabetes, as the recent SOLOIST trial of sotagliflozin in HF also suggested 9 .…”

Early initiation of SGLT2 inhibitors is important, irrespective of ejection fraction: SOLOIST‐WHF in perspective

“…44 SGLT2 inhibitors have also been shown to have favourable effects on left ventricular remodelling in people with and without diabetes and in those with systolic or diastolic dysfunction. [45][46][47][48] While most of these mechanisms have been described with SGLT2 inhibitors per se, it is important to point out that sotagliflozin also Figure 2 The natural history of worsening heart failure and the stages of worsening heart failure that have been evaluated in clinical trial settings. DAPA-HF, Study to Evaluate the Effect of Dapagliflozin on the Incidence of Worsening Heart Failure or Cardiovascular Death in Patients With Chronic Heart Failure; EF, ejection fraction; EMPEROR-Reduced, EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction; GDMT, guideline-directed medical therapy; HFrEF, heart failure with a reduced ejection fraction; MRA, mineralocorticoid receptor antagonists; RASi, renin-angiotensin system inhibitors; WHF, worsening heart failure.…”

“…Other relevant mechanisms may include an increase in erythropoietin, 43 inhibition of the sympathetic nervous system, 36 improved kidney function, changes in substrate utilization, 38 direct myocardial effects, modulation of autophagy/mitophagy, and a stimulation of a fasting transcriptional paradigm 44 . SGLT2 inhibitors have also been shown to have favourable effects on left ventricular remodelling in people with and without diabetes and in those with systolic or diastolic dysfunction 45–48 . While most of these mechanisms have been described with SGLT2 inhibitors per se, it is important to point out that sotagliflozin also inhibits SGLT1, which may have additional glycaemic and cardiovascular benefit 49 .…”

Should SGLT2i be used prior to transcatheter edge‐to‐edge repair for secondary mitral regurgitation?

“…As advances in GDMT occur, the role and timing of mitral valve TEER should be continually assessed. Sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) are the newest therapy to show significant benefit in patients with HFrEF 4,5 . The potential use of SGLT2i prior to mitral valve TEER will be discussed in detail below.…”