What proportion of patients with heart failure and preserved ejection fraction are eligible for empagliflozin?

Monzo, Luca; Ferrari, Ilaria; Cicogna, F; Tota, Claudia; Calò, Leonardo

doi:10.2459/jcm.0000000000001331

Cited by 7 publications

(3 citation statements)

References 10 publications

(18 reference statements)

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“…SGLT2is have an excellent diuretic and metabolic effect, as well as they may exert several other mechanisms, including neurohormonal modulation and reducing oxidative stress, inflammation and cardiovascular remodeling [ 172 ] ( Figure 2 ). Experimental and clinical studies have demonstrated an excellent nephroprotective effect for this class of drugs, even stronger than that shown by ACEi or ARBs, which are considered the most effective drugs for preserving kidney function in HF patients [ 173 , 174 ]. By inhibiting Na + /glucose cotransporter 2, SGLT2i improves glycemic control and reduces intravascular volume, as well as reduces intraglomerular pressure by contrasting tubuloglomerular feedback with a consequent protective effect on the glomerular endothelium [ 175 ].…”

Section: Therapeutic Strategies In Crsmentioning

confidence: 99%

New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy

Gallo

Lanza

Savoia

2023

IJMS

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Cardiorenal syndrome consists in the coexistence of acute or chronic dysfunction of heart and kidneys resulting in a cascade of feedback mechanisms and causing damage to both organs associated with high morbidity and mortality. In the last few years, different biomarkers have been investigated with the aim to achieve an early and accurate diagnosis of cardiorenal syndrome, to provide a prognostic role and to guide the development of targeted pharmacological and non-pharmacological therapies. In such a context, sodium-glucose cotransporter 2 (SGLT2) inhibitors, recommended as the first-line choice in the management of heart failure, might represent a promising strategy in the management of cardiorenal syndrome due to their efficacy in reducing both cardiac and renal outcomes. In this review, we will discuss the current knowledge on the pathophysiology of cardiorenal syndrome in adults, as well as the utility of biomarkers in cardiac and kidney dysfunction and potential insights into novel therapeutics.

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Section: Therapeutic Strategies In Crsmentioning

confidence: 99%

New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy

Gallo

Lanza

Savoia

2023

IJMS

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“…Inhibitors of sodium-glucose cotransporter-2 receptors (SGLT-2i) represent a pillar of the modern HF therapy due to their beneficial effect on the reduction of adverse cardiovascular events in HF patients across the entire ejection fraction spectrum, and their broad eligibility [ 89 , 90 , 91 ]. Although their mechanisms of action in HF are still debated, there is increasing evidence that SGLT-2i can reduce cardiac fibrosis and hypertrophy, lowering LV filling pressures in experimental models of HFpEF [ 92 , 93 ].…”

Section: Potential Of Epicardial Adipose Tissue In Heart Failure As T...mentioning

confidence: 99%

The Different Pathways of Epicardial Adipose Tissue across the Heart Failure Phenotypes: From Pathophysiology to Therapeutic Target

Rossi

Gruebler

Monzo

et al. 2023

IJMS

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Epicardial adipose tissue (EAT) is an endocrine and paracrine organ constituted by a layer of adipose tissue directly located between the myocardium and visceral pericardium. Under physiological conditions, EAT exerts protective effects of brown-like fat characteristics, metabolizing excess fatty acids, and secreting anti-inflammatory and anti-fibrotic cytokines. In certain pathological conditions, EAT acquires a proatherogenic transcriptional profile resulting in increased synthesis of biologically active adipocytokines with proinflammatory properties, promoting oxidative stress, and finally causing endothelial damage. The role of EAT in heart failure (HF) has been mainly limited to HF with preserved ejection fraction (HFpEF) and related to the HFpEF obese phenotype. In HFpEF, EAT seems to acquire a proinflammatory profile and higher EAT values have been related to worse outcomes. Less data are available about the role of EAT in HF with reduced ejection fraction (HFrEF). Conversely, in HFrEF, EAT seems to play a nutritive role and lower values may correspond to the expression of a catabolic, adverse phenotype. As of now, there is evidence that the beneficial systemic cardiovascular effects of sodium-glucose cotransporter-2 receptors-inhibitors (SGLT2-i) might be partially mediated by inducing favorable modifications on EAT. As such, EAT may represent a promising target organ for the development of new drugs to improve cardiovascular prognosis. Thus, an approach based on detailed phenotyping of cardiac structural alterations and distinctive biomolecular pathways may change the current scenario, leading towards a precision medicine model with specific therapeutic targets considering different individual profiles. The aim of this review is to summarize the current knowledge about the biomolecular pathway of EAT in HF across the whole spectrum of ejection fraction, and to describe the potential of EAT as a therapeutic target in HF.

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“…Moreover, SGLT2 inhibitors can be easily implemented in the complex HF therapy (single dose, low impact on blood pressure, no impact on heart rate) fitting almost all treatment strategies. 30 Finally, clinical inertia should be avoided considering the broad eligibility to these drugs, 31 , 32 and the consequent expected strong clinical benefit in the treated population.…”

Section: Introductionmentioning

confidence: 99%

Sodium-glucose co-transporter 2 inhibitors in heart failure: an updated evidence-based practical guidance for clinicians

Monzo

Ferrari

Cicogna

et al. 2023

European Heart Journal Supplements

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The sodium-glucose co-transporter 2 (SGLT2) inhibitors have been shown to reduce risks of clinical events in patients with heart failure (HF), with early and sustained benefits regardless of ejection fraction, diabetic status, and care setting. As part and parcel of the modern foundational HF therapy, clinicians should be familiar with these drugs, in order to implement their use and limit the potential adverse effects. We present an up-to-date review of current evidence and a practical guide for the prescription of SGLT2 inhibitors in patients with HF, highlighting important elements for patient selection, treatment initiation, dosing, and problem solving.

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What proportion of patients with heart failure and preserved ejection fraction are eligible for empagliflozin?

Cited by 7 publications

References 10 publications

New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy

New Insight in Cardiorenal Syndrome: From Biomarkers to Therapy

The Different Pathways of Epicardial Adipose Tissue across the Heart Failure Phenotypes: From Pathophysiology to Therapeutic Target

Sodium-glucose co-transporter 2 inhibitors in heart failure: an updated evidence-based practical guidance for clinicians

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