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Bone marrow-derived naïve B lymphocytes improve heart function after myocardial infarction: a novel cardioprotective mechanism for empagliflozin - Basic Research in Cardiology

The role of adaptive immunity in myocardial recovery post myocardial infarction (MI), particularly the immune response by B lymphocytes, remains elusive. Bone marrow immune microenvironment in response to MI is ..... see more

Source : https://link.springer.com/article/10.1007/s00395-022-00956-1


Conclusions: These findings provide new mechanistic insights into regulation of adaptive immune response post MI, and support targeting bone marrow B cell development for improved ventricular remodeling and reduced heart failure after MI.


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Transvenous Right Greater Splanchnic Nerve Ablation in Heart Failure and Preserved Ejection Fraction: First-in-Human Study

Ablation of the right-sided greater splanchnic nerve (GSN) can reduce excessive splanchnic vasoconstriction, potentially improving the handling of volume shifts in patients with heart failure with preserved ejection fraction (HFpEF). ..... see more

Source : https://www.sciencedirect.com/science/article/pii/S221317792200316X?via=ihub


Conclusions: In this open-label, single-arm feasibility study, right-sided GSN ablation was safe and improved mostly subjective clinical metrics in patients with HFpEF over 12 months.


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Periodontal Status, C-Reactive Protein, NT-proBNP, and Incident Heart Failure: The ARIC Study

Periodontal disease (PD), resulting from inflammatory host response to dysbiotic subgingival microbiota, has been linked to cardiovascular disease; however, its relationship to heart failure (HF) and its subtypes (heart failure ..... see more

Source : https://www.sciencedirect.com/science/article/abs/pii/S2213177922003146?via=ihub


Conclusions: Periodontal status was associated with incident HF, HFpEF, and HFrEF, as well as unfavorable changes in CRP and NT-proBNP.

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Defining the Phenotypes for Heart Failure With Preserved Ejection Fraction - Current Heart Failure Reports

Purpose of Review Heart failure with preserved ejection fraction (HFpEF) imposes a significant burden on society and healthcare. The lack in efficacious therapies is likely due to the significant heterogeneity ..... see more

Source : https://link.springer.com/article/10.1007/s11897-022-00582-x


Summary: We synthesized the literature and propose three broad phenotypes: (1) young, with few comorbidities, usually obese and with low natriuretic peptide levels, (2) obese with substantive cardiometabolic burden and comorbidities and impaired ventricular relaxation, (3) old, multimorbid, with high rates of atrial fibrillation, renal and...

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Consider the safety profile of this heart failure treatment

In February 2022, the FDA approved empagliflozin to decrease the risk of cardiovascular death and hospitalization in adults with heart failure. With regard to cardiovascular indications, this agent has also been approved to decrease the risk of cardiovascular death in adults with type 2 diabetes and pre-existing cardiovascular disease, as well as to decrease the risk of death/hospitalization in individuals with heart failure and low ejection fraction.

The safety and effectiveness of empagliflozin were compared with standard of care in a randomized, double-blind trial. Overall, the adverse effects of this agent were similar to those of patients with diabetes. In patients with heart failure with preserved ejection fraction (HFpEF), acute renal failure, hypotension, and urinary tract infections were the most common adverse effects of interest, whereas in patients with heart failure with reduced ejection fraction (HFrEF), volume depletion, symptomatic hypotension, and urinary tract infections were most common. Empagliflozin should not be prescribed to patients who are allergic or to those on dialysis. Before prescribing empagliflozin, it is important to carefully consider risk factors for diabetic ketoacidosis (DKA), as this agent increases the risk of DKA.

What has been your clinical experience with adverse events secondary to the administration of empagliflozin? How do you manage these adverse events? When do you decide to discontinue this agent?

STEPHEN MALONE Commented on a Post
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Case 1: A 68-year-old female patient presents with fatigue, chest pain, palpitations, dyspnea, and syncope while performing normal physical activity. She is comfortable at rest, with limited impairment of functional status. She is categorized as having HFpEF NYHA Class II, with an LVEF of 58% and an eGFR of 61 mL/min/1.73 m2. She is currently taking ACE inhibitors and diuretics.

Case 2: A 65-year-old man is experiencing symptoms fatigue, chest pain, palpitations, dyspnea, and syncope with less than normal physical activity. He is comfortable at rest only, with limitations on functional status. He recently transitioned to HFpEF NYHA Class III, with an LVEF of 35% and eGFR of 58 mL/min/1.73 m2. He is currently taking an ARB, diuretic, and beta blocker.

In both patients, the addition of which agent would result in a relative risk reduction in time to cardiovascular death or hospitalization due to heart failure? Before prescribing this drug, in which patients should renal function and volume status be tested? What are the most common adverse reactions for this drug (i.e., occurring in ≥5% of patients)?

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  • September 29, 2022
    Jardiance can be helpful in both patients. I would assure creatinine clearance is above 25 cc/min before prescribing SGLT2 inhibitor like Jardiance. Volume status should be assessed clinically from physical Show More
  • September 29, 2022
    I would start with adding spironolactone and empaliflozin in patient 1 and recheck renal function and electrolytes in 1-2 weeks. In patient 2, I would change ARB to Entresto and Show More
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Managing Heart Failure With Reduced Ejection Fraction in Patients With Chronic Kidney Disease: A Case-Based Approach and Contemporary Review

The pharmacologic management of heart failure with reduced ejection fraction (HFrEF) is well established. Contemporary foundational treatment of HFrEF includes the following 4 standard therapies: (i) a renin-angiotensin system (RAS) ..... see more

Source : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486859/


Conclusion/Relevance: The sodium-glucose cotransporter 2 inhibitors are effective at reducing adverse cardiovascular and renal outcomes in patients with HFrEF and CKD (eGFR ≥ 25 mL/min per 1.73 m2 with dapagliflozin or ≥ 20 mL/min per 1.73 m2 with empagliflozin), although declining kidney function is a risk, due to the osmotic diuretic...

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Effect of Empagliflozin and Dapagliflozin on Ambulatory Arterial Stiffness in Patients with Type 2 Diabetes Mellitus and Cardiovascular Co-Morbidities: A Prospective, Observational Study - PubMed

Background and Objectives : Individuals with type 2 diabetes mellitus (T2DM) have an increased risk of cardiovascular disease. Arterial stiffness is an independent prognostic marker for cardiovascular disease development. We ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36143844/


Conclusions: Conclusions: SGLT-2 inhibitor treatment with empagliflozin or dapagliflozin in subjects with T2DM failed to improve ambulatory PWV over a mean follow-up of 10 months.


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Sodium-glucose Co-transporter-2 inhibitors (SGLT2I): A class of drugs with promising cardiorenal protective effects beyond glycemic control

Diabetes Mellitus is always associated with both microvascular and macrovascular complications. Cardiovascular and renal complications are the leading cause of morbidity and mortality in these populations. Sodium-glucose co-transporter 2 inhibitors ..... see more

Source : https://www.sciencedirect.com/science/article/pii/S2049080122012961?via=ihub



Relevance: In this brief review, we outline the potential cardiorenal benefits of these drugs and their future implication to improve glycemic, cardiovascular, and renal outcomes.



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Empagliflozin reduces cardiorenal events, healthcare resource use and mortality in Sweden compared to dipeptidyl peptidase-4 inhibitors: real world evidence from the Nordic EMPRISE study - PubMed

doi: 10.1111/dom.14870. Online ahead of print. Collaborators, Affiliations 1 Department of clinical science and education Karolinska Institutet, Södersjukhuset, Stockholm, Sweden. 2 Quantify Research, Stockholm, Sweden. 3 Department of Medicine, Huddinge, ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36097728/


Conclusions: Empagliflozin treatment compared to DPP-4i reduced cardiorenal events and overall mortality, which may explain lower HCRU among empagliflozin users in Sweden.

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Effects of Empagliflozin in Women and Men With Heart Failure and Preserved Ejection Fraction - PubMed

2022 Sep 13;101161CIRCULATIONAHA122059755. doi: 10.1161/CIRCULATIONAHA.122.059755. Online ahead of print. 1 Department of Medicine, University of Mississippi School of Medicine, Jackson (J.B., T.J.S.). 2 Baylor Scott and White Research Institute, Dallas, ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36098051/


Conclusions: Empagliflozin produced similar benefits on outcomes and health status in women and men with HF and preserved ejection fraction.

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Different Doses of Empagliflozin in Patients with Heart Failure with Reduced Ejection Fraction

It was unclear whether there are discrepancies among the efficacy and safety of different doses of empagliflozin in patients with heart failure with reduced ejection fraction (HFrEF). The aim of ..... see more

Source : https://www.jstage.jst.go.jp/article/ihj/advpub/0/advpub_22-151/_article


Conclusions: The results from this study suggested that 25 mg of empagliflozin might be better than 10 mg in improving heart function in HFrEF patients, and the safety profiles of 25 mg and 10 mg of empagliflozin are comparable. Further studies are expected to substantiate our speculations.

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Heart failure outcomes according to heart rate and effects of empagliflozin in patients of the EMPEROR-Preserved Trial - PubMed

doi: 10.1002/ejhf.2677. Online ahead of print. 1 Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Kirrberger Str.1, 66421 Homburg/Saar, Germany and Cape Heart Institute, Cape Town, SA. 2 ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36087309/


Conclusions: RHR associates with outcomes only in sinus rhythm but not in AF. Empagliflozin reduced outcomes over the entire RHR spectrum without increase of adverse events. This article is protected by copyright. All rights reserved.

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Renal effects of empagliflozin in patients hospitalized for acute heart failure: from the EMPULSE trial - PubMed

In patients hospitalized for acute heart failure, empagliflozin caused an early modest decline in renal function which was no longer evident after 90 days. Acute renal events were similar in ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36066557/


Conclusion: In patients hospitalized for acute heart failure, empagliflozin caused an early modest decline in renal function which was no longer evident after 90 days. Acute renal events were similar in both groups. The clinical benefit of empagliflozin was consistent regardless of baseline renal function.

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Cumulative Complexity: A qualitative analysis of patients' experiences of living with heart failure with preserved ejection fraction - PubMed

The constellation of HFpEF, multimorbidity and aging creates many demands that people with HFpEF are expected to manage. Concurrently, the same syndromes threaten their ability to physically enact this work. ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36073202/


Conclusions: The constellation of HFpEF, multimorbidity and aging creates many demands that people with HFpEF are expected to manage. Concurrently, the same syndromes threaten their ability to physically enact this work. Patients' recollections of their interactions with health professionals suggest there is widespread misunderstanding of...

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Impact of breakthrough trials on prescription trends of sodium-glucose cotransporter-2 inhibitors in Japan: An interrupted time-series analysis - PubMed

The breakthrough trials increased prescription rates not only for patients to whom the trial results could be extrapolated but also for those in whom trial benefits were not certain. Our ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36068684/


Conclusions: What is new and conclusion: The breakthrough trials increased prescription rates not only for patients to whom the trial results could be extrapolated but also for those in whom trial benefits were not certain. Our findings suggest that information about breakthrough trials may need to be provided along with data on trial result...

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Heart Failure With Preserved Ejection Fraction as an Exercise Deficiency Syndrome: JACC Focus Seminar 2/4

Available online 5 September 2022 Across differing spectrums of cardiac function and cardiac pathologies, there are strong associations between measures of cardiorespiratory fitness and burden of symptoms, quality of life, ..... see more

Source : https://www.sciencedirect.com/science/article/abs/pii/S0735109722056030?via=ihub


Relevance: Across differing spectrums of cardiac function and cardiac pathologies, there are strong associations between measures of cardiorespiratory fitness and burden of symptoms, quality of life, and prognosis. In this part 2 of a 4-part series, we contend that there is a strong association among physical activity, cardiorespiratory...

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Empagliflozin in acute Myocardial Infarction: the EMMY trial - PubMed

doi: 10.1093/eurheartj/ehac494. Online ahead of print. 1 Medical University of Graz, Department of Internal Medicine, Division of Cardiology, Graz, Austria. 2 Medical University of Graz, Department of Internal Medicine, Division ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36036746/



Conclusions: In patients with a recent myocardial infarction, empagliflozin was associated with a significantly greater NT-proBNP reduction over 26 weeks, accompanied by a significant improvement in echocardiographic functional and structural parameters.

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Renal Effects of Empagliflozin in Patients with Type 2 Diabetes Mellitus - PubMed

Type 2 diabetes mellitus (T2DM) is one of the main causes of mortality and morbidity worldwide. It leads to various long-term complications such as diabetic nephropathy. Diabetes nephropathy is the ..... see more

Source : https://pubmed.ncbi.nlm.nih.gov/36045524/


Conclusions: Sodium-glucose cotransporter 2 inhibitor of empagliflozin is a potent anti-hyperglycemic agent. In addition, it has been shown to have some pharmacologic potentials to provide renoprotective effects in patients with T2DM. In current study, we review the available clinical data on the potential renoprotective effects of this drug...

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Impact of sodium glucose cotransporter-2 inhibitors on liver steatosis/fibrosis/inflammation and redox balance in non-alcoholic fatty liver disease

Sodium glucose cotransporter-2 inhibitors (SGLT2-I) are the most recently approved drugs for type 2 diabetes (T2D). Recent clinical trials of these compounds reported beneficial cardiovascular (CV) and renal outcomes. A ..... see more

Source : https://www.wjgnet.com/1007-9327/full/v28/i26/3243.htm


Conclusions:The present data indicate that treatment with SGLT2-I in patients with T2D and NAFLD is associated with improvement of liver steatosis and fibrosis markers and circulating pro-inflammatory and redox status, more than optimizing glycemic control.