{"id":"fe56384cc3e0","type":"article","url":"https://hartvaat.nl/2024/06/11/effort-ertugliflozine-bij-functionele-mitralisinsufficientie-en-hartfalen/","title":"EFFORT: ertugliflozine bij functionele mitralisinsufficiëntie en hartfalen","title_en":"Ertugliflozin for Functional Mitral Regurgitation Associated With Heart Failure: EFFORT Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","canagliflozine","carvedilol","cystatine-c","dapagliflozine","empagliflozine","emperor-trials","hfmref","hfpef","hfref","mitralisinsufficiëntie","nt-probnp","sglt2-remmers","step-hfpef","vericiguat"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.124.069144","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.124.069144","authors":["Duk-Hyun Kang","Sung-Ji Park","Sung-Hee Shin","In-Chang Hwang","Yeonyee Elizabeth Yoon","Hyung-Kwan Kim","Mijin Kim","Min-Seok Kim","Sung-Cheol Yun","Jong-Min Song","Seok-Min Kang"],"significance":7,"published":"2024-06-11","source_date":"2024-06-11","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"The EFFORT trial explored whether the SGLT2 inhibitor ertugliflozin reduces functional mitral regurgitation in heart failure, testing the hypothesis that volume management through SGLT2 inhibition can improve secondary valvular disease.","created":"2026-07-03T10:30:59Z","updated":"2026-07-03T18:39:10Z","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":"De EFFORT-trial onderzocht of de SGLT2-remmer ertugliflozine functionele mitralisinsufficiëntie bij hartfalen vermindert. De interventie verbeterde de MR-ernst niet significant, wat suggereert dat SGLT2-remmers de MR niet direct beïnvloeden.","abstract_original":"BACKGROUND: The morbidity and mortality rates of patients with heart failure (HF) and functional mitral regurgitation (MR) remain substantial despite guideline-directed medical therapy for HF. We evaluated the efficacy of ertugliflozin for reduction of functional MR associated with HF with mild to moderately reduced ejection fraction. METHODS: The EFFORT trial (Ertugliflozin for Functional Mitral Regurgitation) was a multicenter, double-blind, randomized trial to examine the hypothesis that the sodium-glucose cotransporter 2 inhibitor ertugliflozin is effective for improving MR in patients with HF with New York Heart Association functional class II or III, 35%≤ejection fraction<50%, and effective regurgitant orifice area of chronic functional MR >0.1 cm2 on baseline echocardiography. We randomly assigned 128 patients to receive either ertugliflozin or placebo in addition to guideline-directed medical therapy for HF. The primary end point was change in effective regurgitant orifice area of functional MR from baseline to the 12-month follow-up. Secondary end points included changes in regurgitant volume, left ventricular (LV) volume indices, left atrial volume index, LV global longitudinal strain, and NT-proBNP (N-terminal pro-B-type natriuretic peptide). RESULTS: The treatment groups were generally well-balanced with regard to baseline characteristics: mean age, 66±11 years; 61% men; 13% diabetes; 51% atrial fibrillation; 43% use of angiotensin receptor-neprilysin inhibitor; ejection fraction, 42±8%; and effective regurgitant orifice area, 0.20±0.12 cm2. The decrease in effective regurgitant orifice area was significantly greater in the ertugliflozin group than in the placebo group (-0.05±0.06 versus 0.03±0.12 cm2; P<0.001). Compared with placebo, ertugliflozin significantly reduced regurgitant volume by 11.2 mL (95% CI, -16.1 to -6.3; P=0.009), left atrial volume index by 6.0 mL/m2 (95% CI, -12.16 to 0.15; P=0.005), and LV global longitudinal strain by 1.44% (95% CI, -2.42% to -0.46%; P=0.004). There were no significant between-group differences regarding changes in LV volume indices, ejection fraction, or NT-proBNP levels. Serious adverse events occurred in one patient (1.6%) in the ertugliflozin group and 6 (9.2%) in the placebo group (P=0.12). CONCLUSIONS: Among patients with functional MR associated with HF, ertugliflozin significantly improved LV global longitudinal strain and left atrial remodeling, and reduced functional MR. Sodium-glucose cotransporter 2 inhibitors may be considered for patients with functional MR. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT04231331."}