Impact of Empagliflozin on Functional Capacity in Heart Failure With Preserved Ejection Fraction

Study Overview
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Brief Summary
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Sodium-Glucose Cotransporter-2 (SGLT-2) inhibitors generally and empagliflozin specifically have shown cardiovascular benefits in patients with heart failure (HF), but the underlying mechanisms remain unclear. Empagliflozin use resulted in lower pulmonary artery diastolic pressures in patients with HF, suggesting a beneficial diuretic effect. Other potential mechanisms include increased blood volume, decreased blood pressure, and changes in sympathetic and neuro-hormonal activation. This study is a single-arm, open label, prospective interventional study of 8 subjects with heart failure with preserved ejection fraction (HFpEF). Before and after 12 weeks of daily empagliflozin, participants with undergo comprehensive invasive exercise testing with a right heart catheter. Our goal is to evaluate the effects of empagliflozin on fitness, assessed by peak VO2, and peak left ventricular filling pressure, assessed by pulmonary capillary pressure at peak exercise.

Detailed Description
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This is a single-arm, open label, pilot study of 8 subjects with HFpEF. The subjects will undergo screening tests (exercise stress echo and blood work) to evaluate for potential exclusion criteria and provide familiarization to the exercise protocol. Those included will undergo an echocardiogram and invasive cardiopulmonary exercise test. This involves placement of a right heart catheter in the pulmonary artery and undergoing seated, upright exercise. During the exercise test, the subject's oxygen uptake (VO2), intra-cardiac pressures (right atrial pressure, pulmonary capillary wedge pressure) and cardiac output (Qc) will be measured. The subject will take a dose of empagliflozin in the lab and wait for at least 60 minutes. They will repeat a shortened version of the exercise test in the afternoon. After baseline testing, each subject will take 10mg empagliflozin daily for 12 weeks. They will have repeat blood work (specific electrolytes and renal function) 30 days after starting medication to screen for renal injury. After 12 weeks, they will return for another invasive cardiopulmonary exercise test and echocardiogram.

Official Title
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Impact of Empagliflozin on Functional Capacity in Heart Failure With Preserved Ejection Fraction

Conditions
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Heart Failure With Preserved Ejection Fraction, Heart Failure, Diastolic, Diabetes Mellitus

Intervention / Treatment
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* Drug: Empagliflozin 10 MG


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: adults ages 50-85 clinical heart failure ejection fraction > 50% Exclusion Criteria: previous hypersensitivity or adverse reaction to SGLT-2 inhibitors currently treated with SGLT-2 inhibitor current or prior ejection fraction <50% chronic kidney disease with glomerular filtration rate < 45 ml/kg/min unstable coronary artery disease significant arrhythmia BMI >55 kg/m2 inability to exercise.

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Single arm, open label trial
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Treatment Arm<br>This arm of the study will take 10 mg empagliflozin daily for 12 weeks | Drug: Empagliflozin 10 MG<br>* Daily Empagliflozin<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Peak Oxygen Uptake | Peak VO2 measured on maximal exercise test | 12 weeks | 
| Peak Pulmonary Capillary Wedge Pressure (PCWP) | Peak PCWP, measured at end-expiration, at the end of maximal exercise test | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Primary Endpoints after single dose of empagliflozin | Peak VO2 and peak PCWP will be measured after a single dose of empagliflozin | 1 hour | 
| Cardiac Output at Rest and During Exercise |  | 12 weeks | 
| Stroke Volume at Rest and During Exercise |  | 12 weeks | 
| Right Atrial Pressure at Rest and During Exercise |  | 12 weeks | 
| Pulmonary Capillary Wedge Pressure at Rest and During Submaximal Exercise |  | 12 weeks | 
| Left ventricular volumes at rest and during submaximal exercise | Measured by echocardiography | 12 weeks | 
| Hemoglobin mass, plasma volume, total blood volume | Measured by Carbon Monoxide Rebreathe | 12 weeks | 
| Diastolic parameters at rest and during submaximal exercise | Measured by echocardiography | 12 weeks | 
| 6 minute walk time |  | 12 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Exercise, Invasive Exercise Testing, SGLT-2 Inhibitors