Effects of Empagliflozin on Cardiorespiratory Fitness and Significant Interaction of Loop Diuretics

Abstract

Introduction

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.

Methods

In this pilot study we determined the effects of empagliflozin10 mg/day for four weeks on peak oxygen consumption (VO ₂) in 15 patients with T2DM and HFrEF. As exploratory analysis, we assessed whether there was an interaction for the effects of empagliflozin on peak VO ₂ of loop diuretics.

Results

Empagliflozin reduced body weight (−1.7 Kg, p=0.031), but it did not change peak VO ₂ (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=0.95). However, patients on loop diuretics (N=9) demonstrated an improvement, whereas those without loop diuretics (N=6) had a decrease in peak VO ₂ (+0.9[0.1–1.4] vs −0.9[−2.1– −0.3] mL•kg ⁻¹•min ⁻¹, p=0.001), and peak VO ₂ changes correlated with the baseline daily dose of diuretics (R=+0.83, p<0.001).

Conclusions

Empagliflozin did not improve peak VO ₂ in patients with T2DM and HFrEF. However, as result of exploratory analysis, patients concomitantly treated with loop diuretics experienced a significant improvement in peak VO ₂.