Physicians' Academy for Cardiovascular Education

SGLT2 inhibitor reduces epicardial adipose tissue in nondiabetic patients with HFrEF

Mechanistic Insights of Empagliflozin in Nondiabetic Patients With HFrEF: From the EMPA-TROPISM Study

Literature - Requena-Ibáñez JA, Santos-Gallego CG, Rodriguez-Cordero A et al. - JACC Heart Fail. 2021 Aug;9(8):578-589. doi: 10.1016/j.jchf.2021.04.014.

Introduction and methods

The mechanisms of action of SGLT2 inhibitors in HFrEF remain largely unknown. The EMPA-TROPISM study previously showed that empagliflozin significantly improved LV volumes, LV mass, LV systolic function, functional capacity, and quality of life in nondiabetic patients with HFrEF, compared with placebo [1]. The current pre-specified secondary analysis of this study analyzed the effects of empagliflozin on epicardial adipose tissue (EAT), Subcutaneous adipose tissue (SAT), myocardial extracellular volume (ECV), aortic stiffness and inflammatory biomarkers.

A total of 84 nondiabetic adults with HFrEF were randomized in a 1:1 ratio to receive empagliflozin 10 mg daily or matching placebo in addition to optimal medical treatment. Patients underwent CMR scans at baseline and at 6 months post-randomization. Blood was taken from all participants at baseline after 6 months of treatment for the evaluation of plasma biomarkers using proteomics.

Main results


In nondiabetic patients with HFrEF, EAT, SAT, myocardial ECV, matrix volume and cardiomyocyte volume were significantly reduced after 6 months treatment with empagliflozin compared to 6 months placebo. Treatment with empagliflozin also normalized aortic stiffness and reduced several inflammatory biomarkers.


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Find this article online at JACC Heart Fail.

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