Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Saarland, Germany.
Cape Heart Institute, Cape Town, South Africa.
Eur J Heart Fail. 2022 Oct;24(10):1883-1891. doi: 10.1002/ejhf.2677. Epub 2022 Oct 4.
Empagliflozin reduces cardiovascular death (CVD) or heart failure hospitalization (HHF) in patients with heart failure and preserved ejection fraction (HFpEF). Treatment effects and safety in relation to resting heart rate (RHR) have not been studied.
The interplay of RHR and empagliflozin effects in EMPEROR-Preserved was evaluated. We grouped patients (n = 5988) according to their baseline RHR (<70 bpm [n = 2650], 70-75 bpm [n = 967], >75 bpm [n = 1736]) and explored the influence of RHR on CVD or HHF (primary outcome) and its components in sinus rhythm or atrial fibrillation/flutter (AF) and adverse events. We studied the efficacy of empagliflozin across the RHR spectrum. Compared to placebo, empagliflozin did not change heart rate over time. The primary outcome (p for trend = 0.0004) and its components CVD (p trend = 0.0002), first HHF (p for trend = 0.0099) and all-cause death (p < 0.0001) increased with RHR only in sinus rhythm but not AF. The risk increase with RHR was similar in patients with heart failure and mildly reduced ejection fraction (left ventricular ejection fraction [LVEF] 40-49%) and HFpEF (LVEF ≥50%). Baseline RHR had no influence on the effect of empagliflozin on the primary outcomes (p for trend = 0.20), first HHF (p for trend = 0.49). There were no clinically relevant differences in adverse events between empagliflozin and placebo across the RHR groups.
Resting heart rate associates with outcomes only in sinus rhythm but not in AF. Empagliflozin reduced outcomes over the entire RHR spectrum without increase of adverse events.
恩格列净可降低射血分数保留的心衰（HFpEF）患者的心血管死亡（CVD）或心衰住院（HHF）风险。但尚未研究静息心率（RHR）与治疗效果和安全性的关系。
本研究评估了 EMPEROR-Preserved 试验中 RHR 与恩格列净作用的相互关系。我们根据基线 RHR（<70bpm [n=2650]、70-75bpm [n=967]、>75bpm [n=1736]）将患者（n=5988）分组，并探讨了 RHR 对窦性心律或房颤/房扑（AF）时 CVD 或 HHF（主要终点）及其组成部分以及不良事件的影响。我们研究了恩格列净在整个 RHR 范围内的疗效。与安慰剂相比，恩格列净在整个研究期间对心率无影响。主要终点（p 趋势=0.0004）及其组成部分（CVD，p 趋势=0.0002；首次 HHF，p 趋势=0.0099；全因死亡，p<0.0001）仅在窦性心律而非 AF 时随 RHR 增加而增加。在射血分数轻度降低（左室射血分数 [LVEF] 40-49%）和 HFpEF（LVEF≥50%）的心力衰竭患者中，RHR 增加的风险与心力衰竭患者相似。RHR 对恩格列净疗效的影响与主要终点（p 趋势=0.20）、首次 HHF（p 趋势=0.49）无关。在整个 RHR 范围内，恩格列净与安慰剂在不良事件方面没有临床相关差异。
静息心率仅与窦性心律下的结局相关，而与 AF 无关。恩格列净降低了整个 RHR 范围内的结局，且无不良事件增加。
