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Empagliflozin's role in reducing ventricular repolarization heterogeneity: insights into cardiovascular mortality decline from the EMPATHY-HEART trial.
- Source :
-
Cardiovascular diabetology [Cardiovasc Diabetol] 2024 Jun 26; Vol. 23 (1), pp. 221. Date of Electronic Publication: 2024 Jun 26. - Publication Year :
- 2024
-
Abstract
- Background: The incidence of myocardial infarction (MI) and sudden cardiac death (SCD) is significantly higher in individuals with Type 2 Diabetes Mellitus (T2DM) than in the general population. Strategies for the prevention of fatal arrhythmias are often insufficient, highlighting the need for additional non-invasive diagnostic tools. The T-wave heterogeneity (TWH) index measures variations in ventricular repolarization and has emerged as a promising predictor for severe ventricular arrhythmias. Although the EMPA-REG trial reported reduced cardiovascular mortality with empagliflozin, the underlying mechanisms remain unclear. This study investigates the potential of empagliflozin in mitigating cardiac electrical instability in patients with T2DM and coronary heart disease (CHD) by examining changes in TWH.<br />Methods: Participants were adult outpatients with T2DM and CHD who exhibited TWH > 80 µV at baseline. They received a 25 mg daily dose of empagliflozin and were evaluated clinically including electrocardiogram (ECG) measurements at baseline and after 4 weeks. TWH was computed from leads V4, V5, and V6 using a validated technique. The primary study outcome was a significant (p < 0.05) change in TWH following empagliflozin administration.<br />Results: An initial review of 6,000 medical records pinpointed 800 patients for TWH evaluation. Of these, 412 exhibited TWH above 80 µV, with 97 completing clinical assessments and 90 meeting the criteria for high cardiovascular risk enrollment. Empagliflozin adherence exceeded 80%, resulting in notable reductions in blood pressure without affecting heart rate. Side effects were generally mild, with 13.3% experiencing Level 1 hypoglycemia, alongside infrequent urinary and genital infections. The treatment consistently reduced mean TWH from 116 to 103 µV (p = 0.01).<br />Conclusions: The EMPATHY-HEART trial preliminarily suggests that empagliflozin decreases heterogeneity in ventricular repolarization among patients with T2DM and CHD. This reduction in TWH may provide insight into the mechanism behind the decreased cardiovascular mortality observed in previous trials, potentially offering a therapeutic pathway to mitigate the risk of severe arrhythmias in this population.<br />Trial Registration: NCT: 04117763.<br /> (© 2024. The Author(s).)
- Subjects :
- Humans
Male
Female
Middle Aged
Aged
Treatment Outcome
Time Factors
Action Potentials drug effects
Arrhythmias, Cardiac mortality
Arrhythmias, Cardiac diagnosis
Arrhythmias, Cardiac physiopathology
Heart Rate drug effects
Coronary Disease mortality
Coronary Disease physiopathology
Coronary Disease drug therapy
Coronary Disease diagnosis
Electrocardiography
Risk Factors
Benzhydryl Compounds therapeutic use
Benzhydryl Compounds adverse effects
Glucosides therapeutic use
Glucosides adverse effects
Sodium-Glucose Transporter 2 Inhibitors therapeutic use
Sodium-Glucose Transporter 2 Inhibitors adverse effects
Diabetes Mellitus, Type 2 mortality
Diabetes Mellitus, Type 2 diagnosis
Diabetes Mellitus, Type 2 drug therapy
Diabetes Mellitus, Type 2 physiopathology
Subjects
Details
- Language :
- English
- ISSN :
- 1475-2840
- Volume :
- 23
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Cardiovascular diabetology
- Publication Type :
- Academic Journal
- Accession number :
- 38926835
- Full Text :
- https://doi.org/10.1186/s12933-024-02311-1