#EMPEROR PRESERVED trial was recently published in #NEJM in 2021. It was also presented at #ESC2021.
Welcome back to the cardioid youtube channel and podcast after a long time it’s good to be back from a break also what a way to be back today we are discussing the landmark emperor preserve trial so if you are listening to or watching this channel for the first time consider subscribing we discuss the recent advances in cardiology cardiac imaging and cardiac
Interventions also we touch upon the various topics of cardiology we already know that sglt2 inhibitors decrease hospitalization in patients with heart failure with reduced ejection fraction the results of dapp hf and emperor reduced trials have clearly shown the benefits of dapagliflozin and ampergliflozin in patients with hephrev or heart failure with
Reduction fraction in the recently published soloist whf trial sota glyphlosin was found to benefit diabetic patients with heart failure there are multiple mechanisms by which sglt2 inhibitors can benefit half ref patients these include number one natriuresis number two glycosuria and osmotic diuresis number three improvement in glycemic control number four
Anti-hypertensive effect number five weight reduction and number six direct cardiac actions the direct cardiac actions include regulation of ionic homeostasis improved myocardial energetics improved autophagy decreased inflammation and decreased myocardial oxidative stress it was hypothesized that sglt2 inhibitors can possibly benefit patients with heart
Failure with preserved ejection fraction the emperor preserved trial was a double-blinded trial in which around 6000 patients with class 2 to class 4 heart failure with ejection fraction more than 40 percent and anti probnp more than 300 picogram per ml or more than 900 picogram per ml for af patients were randomized into two groups one of the group received
Empagliflozin in the dose of 10 milligrams per day the other group received placebo this was in addition to the routine therapy the mean age of the patients in this study was 72 years female comprised 45 percent of the study population 75 percent of the patients enrolled in the study were whites around 50 for asians 45 of the patients were in europe and 10
Of the patients were in asia 12 percent of patients were in north america and 25 patients were in latin america most of the patients in this study were in nyha two functional class that is around eighty percent patients were in nysa two functional class eighteen percent of patients were nyha three functional class the mean bmi of the patients in this study was
29 kilogram per meter square on an average patients had systolic blood pressure of around 130 mmg mean lvef was around 54 one-third of the patients had ejection fraction between 40 to 50 percent another one third patients had ejection fraction between 50 to 60 percent and one third patients had ejection fraction more than 60 percent around one third patients
Had ischemic etiology of heart failure around 2 3 patients had non-ischemic heart failure around 1 4 of the patients in the study had heart failure hospitalization in last one year around 50 patients were having atrial fibrillation and baseline around 50 patients for diabetic at baseline around 60 patients were hypertensive at baseline and around 50 patients
Had an egfr of less than 60 ml per minute at baseline patients were followed up for a meaning period of for 26 months the primary outcome was a composite of cardiovascular deaths and heart failure hospitalization the trial is found that primary outcome occurred in 13.8 percent patients in the empirical closing group and seventeen point one percent patients
In the placebo group there was a statistically significant reduction in the primary end point in the empire glyphosate group it proved that empagliflozin is superior to placebo in improving heart failure outcomes the benefits were similar among the patients with or without type 2 diabetes mellitus heart failure hospitalization occurred in around nine percent
Patients in the empire glyphosate group and around 12 percent patients in the control group there was a statistically significant reduction in heart failure hospitalization in the empirgly closing group death from cardiovascular cause was seen in around seven percent patients in the empire glyphlosing group and eight percent patients in the control group there
Was no statistically significant difference in all-cause mortality in both the groups this proved that the improved outcome with empacleflozen is primarily due to decrease in heart failure hospitalization and not due to decrease in mortality empirglyflozin was found to decrease total number of hospitalization more than the placebo and this was statistically
Significant empagliflozin also decreased the rate of decline of egfr in the emperor preserve trial ampagliflozin appeared to be effective across the entire spectrum of ejection fraction but there may be a decrement of benefit in patients with higher ejection fraction so what lessons do we learn from this trial we conclude from this trial that ampagliflozin
May be an effective drug in heart failure with preserved digestion fraction it decreases primary outcomes in heart failure preserved ejection fraction primarily by decreasing heart failure hospitalization currently we await the results of the deliver trial which is ongoing and it is assessing the role of dapagliflozin in heart failure with preserved ejection fraction
Transcribed from video
EMPEROR PRESERVED trial. Empagliflozin in HFpEF patients. By Cardio-Ed
