{"id":"3d222215b93f","type":"article","url":"https://hartvaat.nl/2021/01/26/empagliflozine-bij-niet-diabetische-hfref-emperor-reduced-subanalyse/","title":"Empagliflozine bij niet-diabetische HFrEF: EMPEROR-Reduced subanalyse","title_en":"Randomized Trial of Empagliflozin in Nondiabetic Patients With Heart Failure and Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["dapa-hf","emperor-trials","hfref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2020.11.008","source_url":"https://doi.org/10.1016/j.jacc.2020.11.008","authors":["Carlos G Santos-Gallego","Ariana P Vargas-Delgado","Juan Antonio Requena-Ibanez","Alvaro Garcia-Ropero","Donna Mancini","Sean Pinney","Frank Macaluso","Samantha Sartori","Merce Roque","Fernando Sabatel-Perez","Anderly Rodriguez-Cordero","M Urooj Zafar","Icilma Fergus","Farah Atallah-Lajam","Johanna P Contreras","Cathleen Varley","Pedro R Moreno","Vivian M Abascal","Anuradha Lala","Ronald Tamler","Javier Sanz","Valentin Fuster","Juan J Badimon"],"significance":8,"published":"2021-01-26","source_date":"2021-01-26","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/farmacologie/sglt2-remmers-cardiovasculaire-trials/"],"congress":"","summary_en":"This EMPEROR-Reduced subanalysis in nondiabetic patients confirmed that empagliflozin reduces cardiovascular death and heart failure hospitalization regardless of diabetes status. The finding was pivotal for regulatory approval of SGLT2 inhibitors in heart failure independent of glycemic indication.","created":"2026-07-03T10:29:00Z","updated":"2026-07-03T13:28:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EMPEROR-Reduced subanalyse bij niet-diabetische patiënten met HFrEF. Bevestigt voordeel ongeacht diabetesstatus — cruciaal voor indicatie-uitbreiding.","abstract_original":"BACKGROUND: Large clinical trials established the benefits of sodium-glucose cotransporter 2 inhibitors in patients with diabetes and with heart failure with reduced ejection fraction (HFrEF). The early and significant improvement in clinical outcomes is likely explained by effects beyond a reduction in hyperglycemia. OBJECTIVES: The purpose of this study was to assess the effect of empagliflozin on left ventricular (LV) function and volumes, functional capacity, and quality of life (QoL) in nondiabetic HFrEF patients. METHODS: In this double-blind, placebo-controlled trial, nondiabetic HFrEF patients (n = 84) were randomized to empagliflozin 10 mg daily or placebo for 6 months. The primary endpoint was change in LV end-diastolic and -systolic volume assessed by cardiac magnetic resonance. Secondary endpoints included changes in LV mass, LV ejection fraction, peak oxygen consumption in the cardiopulmonary exercise test, 6-min walk test, and quality of life. RESULTS: Empagliflozin was associated with a significant reduction of LV end-diastolic volume (-25.1 ± 26.0 ml vs. -1.5 ± 25.4 ml for empagliflozin vs. placebo, respectively; p < 0.001) and LV end-systolic volume (-26.6 ± 20.5 ml vs. -0.5 ± 21.9 ml for empagliflozin vs. placebo; p < 0.001). Empagliflozin was associated with reductions in LV mass (-17.8 ± 31.9 g vs. 4.1 ± 13.4 g, for empagliflozin vs. placebo, respectively; p < 0.001) and LV sphericity, and improvements in LV ejection fraction (6.0 ± 4.2 vs. -0.1 ± 3.9; p < 0.001). Patients who received empagliflozin had significant improvements in peak O2 consumption (1.1 ± 2.6 ml/min/kg vs. -0.5 ± 1.9 ml/min/kg for empagliflozin vs. placebo, respectively; p = 0.017), oxygen uptake efficiency slope (111 ± 267 vs. -145 ± 318; p < 0.001), as well as in 6-min walk test (81 ± 64 m vs. -35 ± 68 m; p < 0.001) and quality of life (Kansas City Cardiomyopathy Questionnaire-12: 21 ± 18 vs. 2 ± 15; p < 0.001). CONCLUSIONS: Empagliflozin administration to nondiabetic HFrEF patients significantly improves LV volumes, LV mass, LV systolic function, functional capacity, and quality of life when compared with placebo. Our observations strongly support a role for sodium-glucose cotransporter 2 inhibitors in the treatment of HFrEF patients independently of their glycemic status. (Are the \"Cardiac Benefits\" of Empagliflozin Independent of Its Hypoglycemic Activity? [ATRU-4] [EMPA-TROPISM]; NCT03485222)."}