Efficacy of Sodium Glucose Transporter Inhibitor (SGLT2I) in Adult Patients with Congenital Heart Disease

The goal of the study is to investigate the feasibility and benefit of novel guideline-directed heart failure therapy drug Empagliflozin (Jardiance) for adult patients with congenital heart disease (ACHD).

As CHD adolescents transition to adulthood, it is becoming evident that in addition to their structural cardiac abnormalities, they also have an intrinsic disease of the heart muscle which manifests as abnormal heart rhythm (arrhythmia) and decreased function (heart failure).

The lifesaving cardiac surgeries during childhood can also contribute to this dysfunction (cardiomyopathy). Hence, patients with CHD require multiple interventions and close clinical follow-up throughout their life. Currently, there are over 2.5 million CHD patients in the U.S. alone, and an additional 40,000 babies are born with CHD every year. Up to 50% of these patients require inpatient hospital care at some point due to their cardiomyopathy.

High-risk ACHD patients do not receive treatment until they present with heart failure or arrhythmia, at which time there is significant evidence of myocardial disease and dysfunction.

Empagliflozin (Jardiance) is an FDA-approved drug that significantly reduces hospitalization risk and cardiovascular death in adult patients with non-CHD heart failure. Studies show that Empagliflozin protects the heart from inflammation, and preliminary evaluation of Empagliflozin in symptomatic ACHD patients showed improved cardiac function and a reduction in heart failure including decreased shortness of breath and increased functional capacity. Empagliflozin as a preventative therapy may delay the onset of comorbidities by reducing inflammation in ACHD patients.

The study hypothesis is that the administration of once-a-day oral Jardiance (Empagliflozin) medication for one year reduces arrhythmia and cardiomyopathy and lowers serum circulating inflammatory factors and improves neurocognitive outcomes in susceptible ACHD patients.

1. Does Empagliflozin 10 milligrams (MG) improve cardiac function in ACHD patients
2. Does Empagliflozin 10 milligrams (MG) improve functional status in ACHD patients

Eligibility Criteria:
Inclusion Criteria:

* Diagnoses of Congenital Heart Disease
* Age 18+
* ACHD level of structural complexity II or III
* Recent (\<6 months) decrease in systemic Ejection Fraction (confirmed by cardiac Echocardiogram, Computed Tomography or cMRI) to EF \< 60%
* Recent decrease in systemic ejection fraction confirmed by cardiac Echo, CT or MRI by \> 5% in the last 6 months or less.
* Must be able to complete neurocognitive assessments on a handheld computer.

Exclusion Criteria:

* Diagnosed with Diabetes
* Contraindication to Jardiance/Entresto or any heart failure medication (per guideline-directed therapy, 2022).
* Previous therapy with Jardiance at \<4 weeks
* Glomerular Filtration Rate \<20
* Pregnancy, breastfeeding, or planning to become pregnant in the coming year
* History of liver disease - including non-alcoholic fatty liver disease (NAFLD) and cirrhosis
* History of inborn error(s) of metabolism (including but is not exclusive of Glycogen storage disease type 1)
* Glucose-galactose malabsorption, familial hyperinsulinism, maple syrup urine disease,
* Gaucher disease,
* Tay-Sachs disease,
* Mucolipidosis IV,
* Niemann-Pick disease,
* Type A mitochondrial disease,
* Metabolic disorders related to glucose metabolism