Wagdy Kerolos, Nagy Sherif
Aswan Heart Centre, Division of Cardiology, Aswan, Egypt.
Glob Cardiol Sci Pract. 2021 Oct 30;2021(3):e202117. doi: 10.21542/gcsp.2021.17.
Heart failure with preserved ejection fraction (HFpEF) is a complex disease which accounts for more than half of all HF hospital admissions with high prevalence and lack of effective evidence-based management. Sodium-glucose cotransporter 2 (SGLT2) inhibitor is a new antidiabetic drug that recently gained a new role in the management of heart failure with reduced ejection fraction but its role in HFpEF had yet to be studied. EMPEROR-Preserved trial set out to evaluate the effects of SGLT2 inhibition with empagliflozin on major heart failure outcomes in patients with HFpEF. The patients were randomized in a 1:1 fashion into two groups; to receive either empagliflozin 10 mg per day ( = 2, 997) or placebo ( = 2, 991) in addition to usual therapy. Empagliflozin led to a 21% risk reduction of the composite of cardiovascular death or hospitalization for heart failure, which was mainly related to a 29% lower risk of hospitalization for heart failure rather than effect on cardiovascular death empagliflozin. The effects SGLT2 inhibitors were consistent in all patients. The EMPEROR-Preserved trial is the first randomized controlled trial testing the efficacy and safety of SGLT2 inhibitor (empagliflozin) in patients with HFpEF. The trial proves that SGLT2 inhibitors (empagliflozin) can significantly reduce HF hospitalization with neutral effect on cardiovascular (CV) death.
射血分数保留的心力衰竭（HFpEF）是一种复杂的疾病，占所有因心力衰竭住院病例的一半以上，患病率高且缺乏有效的循证管理。钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂是一种新型抗糖尿病药物，最近在射血分数降低的心力衰竭管理中发挥了新作用，但其在HFpEF中的作用尚未得到研究。EMPEROR-Preserved试验旨在评估恩格列净抑制SGLT2对HFpEF患者主要心力衰竭结局的影响。患者以1:1的比例随机分为两组；除常规治疗外，一组接受每日10毫克恩格列净（n = 2,997），另一组接受安慰剂（n = 2,991）。恩格列净使心血管死亡或因心力衰竭住院的复合风险降低了21%，这主要与因心力衰竭住院风险降低29%有关，而非对心血管死亡的影响。SGLT2抑制剂对所有患者的作用是一致的。EMPEROR-Preserved试验是首个测试SGLT2抑制剂（恩格列净）对HFpEF患者疗效和安全性的随机对照试验。该试验证明，SGLT2抑制剂（恩格列净）可显著减少因心力衰竭住院，对心血管（CV）死亡无影响。
