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Effects of Empagliflozin on Left Ventricular Diastolic Function in Addition to Usual Care in Individuals with Type 2 Diabetes Mellitus - Results from the Randomized, Double-blind, Placebo-controlled EmDia Trial

Jürgen ProchaskaClaus Heinrich JüngerAndreas SchulzNatalie ArnoldFelix MüllerMarc HeidornRieke BaumkötterDaniela ZahnThomas KoeckSven-Oliver TröbsKarl J. LacknerAndreas DaiberHarald BinderSanjiv J. ShahTommaso GoriThomas MünzelPhilipp Wild

出版	Universität, 2023
URL	http://books.google.com.hk/books?id=3c8h0AEACAAJ&hl=&source=gbs_api

註釋

Abstract: Background
The sodium-glucose co-transporter 2 inhibitor empagliflozin improves cardiovascular outcome in patients with type 2 diabetes mellitus (T2DM) and heart failure. Experimental studies suggest a direct cardiac effect of empagliflozin associated with an improvement in left ventricular diastolic function.

Methods
In the randomized, double-blind, two-armed, placebo-controlled, parallel group trial EmDia, patients with T2DM and elevated left ventricular E/E ́ ratio were enrolled and randomized 1:1 to receive empagliflozin 10 mg/day versus placebo. The primary endpoint was the change of left ventricular E/E ́ ratio after 12 weeks of intervention.

Results
A total of 144 patients with T2DM and an elevated left ventricular E/e ́ ratio (age 68.9 ± 7.7 years; 14.1% women; E/e ́ ratio 9.61[8.24/11.14], left ventricular ejection fraction 58.9% ± 5.6%). After 12 weeks of intervention, empagliflozin resulted in a significant higher decrease in the primary endpoint E/e ́ ratio by − 1.18 ([95% confidence interval (CI) − 1.72/− 0.65]; P 0.0001) compared with placebo. The beneficial effect of empagliflozin was consistent across all subgroups and also occurred in subjects with heart failure and preserved ejection fraction (n = 30). Additional effects of empagliflozin on body weight, HbA1c, uric acid, red blood cell count, hemoglobin, mean corpuscular hemoglobin, and hematocrit were detected (all P 0.001). Approximately one-third of the reduction in E/e ́ by empagliflozin could be explained by the variables examined.brbrConclusionsbrEmpagliflozin improves diastolic function in patients with T2DM and elevated end-diastolic pressure. Since the positive effects were consistent in patients with and without heart failure with preserved ejection fraction, the data add a mechanistic insight for the beneficial cardiovascular effect of empagliflozin.br