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Effects of empagliflozin on cardiorespiratory fitness and significant interaction of loop diuretics.

ABSTRACT: The effects of empagliflozin on cardiorespiratory fitness in patients with type 2 diabetes mellitus (T2DM) and heart failure with reduced ejection fraction (HFrEF) are unknown. In this pilot study we determined the effects of empagliflozin 10?mg/d for 4?weeks on peak oxygen consumption (VO2 ) in 15 patients with T2DM and HFrEF. As an exploratory analysis, we assessed whether there was an interaction of the effects of empagliflozin on peak VO2 of loop diuretics. Empagliflozin reduced body weight (-1.7?kg; P?=?.031), but did not change peak VO2 (from 14.5?mL kg-1 min-1 [12.6-17.8] to 15.8 [12.5-17.4] mL?kg-1 min-1 ; P?=?.95). However, patients using loop diuretics (N?=?9) demonstrated an improvement, whereas those without loop diuretics (N?=?6) experienced a decrease in peak VO2 (+0.9 [0.1-1.4] vs -0.9 [-2.1 to -0.3] mL?kg-1 min-1 ; P?=?.001), and peak VO2 changes correlated with the baseline daily dose of diuretics (R?=?+0.83; P?

SUBMITTER: Carbone S

PROVIDER: S-EPMC6043379 | biostudies-literature | 2018 Aug

REPOSITORIES: biostudies-literature

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Effects of empagliflozin on cardiorespiratory fitness and significant interaction of loop diuretics.

Carbone Salvatore S Canada Justin M JM Billingsley Hayley E HE Kadariya Dinesh D Dixon Dave L DL Trankle Cory R CR Buckley Leo F LF Markley Roshanak R Vo Chau C Medina de Chazal Horacio H Christopher Sanah S Buzzetti Raffaella R Van Tassell Benjamin W BW Abbate Antonio A

Diabetes, obesity & metabolism 20180423 8

The effects of empagliflozin on cardiorespiratory fitness in patients with type 2 diabetes mellitus (T2DM) and heart failure with reduced ejection fraction (HFrEF) are unknown. In this pilot study we determined the effects of empagliflozin 10 mg/d for 4 weeks on peak oxygen consumption (VO<sub>2</sub> ) in 15 patients with T2DM and HFrEF. As an exploratory analysis, we assessed whether there was an interaction of the effects of empagliflozin on peak VO<sub>2</sub> of loop diuretics. Empagliflozi ...[more]

PMID: 29603546

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Project description:Background and aimsTo examine the decongestive effect of the sodium-glucose cotransporter 2 inhibitor dapagliflozin compared to the thiazide-like diuretic metolazone in patients hospitalized for heart failure and resistant to treatment with intravenous furosemide.Methods and resultsA multi-centre, open-label, randomized, and active-comparator trial. Patients were randomized to dapagliflozin 10 mg once daily or metolazone 5-10 mg once daily for a 3-day treatment period, with follow-up for primary and secondary endpoints until day 5 (96 h). The primary endpoint was a diuretic effect, assessed by change in weight (kg). Secondary endpoints included a change in pulmonary congestion (lung ultrasound), loop diuretic efficiency (weight change per 40 mg of furosemide), and a volume assessment score. 61 patients were randomized. The mean (±standard deviation) cumulative dose of furosemide at 96 h was 977 (±492) mg in the dapagliflozin group and 704 (±428) mg in patients assigned to metolazone. The mean (±standard deviation) decrease in weight at 96 h was 3.0 (2.5) kg with dapagliflozin compared to 3.6 (2.0) kg with metolazone [mean difference 0.65, 95% confidence interval (CI) -0.12,1.41 kg; P = 0.11]. Loop diuretic efficiency was less with dapagliflozin than with metolazone [mean 0.15 (0.12) vs. 0.25 (0.19); difference -0.08, 95% CI -0.17,0.01 kg; P = 0.10]. Changes in pulmonary congestion and volume assessment score were similar between treatments. Decreases in plasma sodium and potassium and increases in urea and creatinine were smaller with dapagliflozin than with metolazone. Serious adverse events were similar between treatments.ConclusionIn patients with heart failure and loop diuretic resistance, dapagliflozin was not more effective at relieving congestion than metolazone. Patients assigned to dapagliflozin received a larger cumulative dose of furosemide but experienced less biochemical upset than those assigned to metolazone.Trial registrationClinicalTrials.gov Identifier: NCT04860011.

Dataset Information

Effects of empagliflozin on cardiorespiratory fitness and significant interaction of loop diuretics.

Publications

Effects of empagliflozin on cardiorespiratory fitness and significant interaction of loop diuretics.

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