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Clinical Trial
. 2025 May;114(5):629-639.
doi: 10.1007/s00392-024-02523-1. Epub 2024 Sep 16.

Impact of empagliflozin on cardiac structure and function assessed by echocardiography after myocardial infarction: a post-hoc sub-analysis of the emmy trial

Nora Schwegel  1 , Christoph Strohhofer  1 , Ewald Kolesnik  2 , Sabrina Oltean  1 , Alexander Hüttmair  1 , Christian Pipp  1 , Martin Benedikt  1 , Nicolas Verheyen  1 , Johannes Gollmer  1 , Klemens Ablasser  1 , Markus Wallner  1 , Viktoria Santner  1 , Norbert Tripolt  3 , Peter Pferschy  3 , Peter Zechner  4 , Hannes Alber  5 , Jolanta M Siller-Matula  6 , Kristen Kopp  7 , Andreas Zirlik  1 , Faisal Aziz  3 , Harald Sourij #  3 , Dirk von Lewinski #  1
Affiliations
Clinical Trial

Impact of empagliflozin on cardiac structure and function assessed by echocardiography after myocardial infarction: a post-hoc sub-analysis of the emmy trial

Nora Schwegel et al. Clin Res Cardiol. 2025 May.

Abstract

Background: Empagliflozin administered after acute myocardial infarction proofed to improve cardiometabolic parameters and biomarkers, but the impact on cardiac function is still largely unknown. The aim of this post-hoc echocardiographic sub-analysis of the EMMY trial was to provide in-depth echocardiographic analysis on the effects of empagliflozin versus placebo on standard and novel echocardiographic structural and functional parameters after acute myocardial infarction.

Methods: In this post-hoc analysis of the EMMY trial a subset of 313 patients (157 empagliflozin vs. 156 placebo) was enrolled for post-processing analysis of echocardiographic structural and functional parameters. On top of two-dimensional and Doppler parameters, myocardial deformation analyses were performed to assess ventricular and atrial strain values.

Results: Left ventricular volumes showed significant differences in favor of empagliflozin over the course of the trial (change in left ventricular end-diastolic volume median [interquartile range] 8 [-3;19]% versus 13 [0;29]%, p = 0.048; left ventricular end-systolic volume -3 [-15;12]% versus 4 [-12;18]%, p = 0.044). This effect persisted after adjusting for baseline values, age, and sex. Left ventricular systolic and diastolic function overall improved over the course of the trial and parameters for diastolic function showed a distinct trend between groups but did not meet statistical significance in this cohort.

Conclusion: In this post-hoc analysis among patients with acute myocardial infarction, treatment with empagliflozin resulted in a significant beneficial effect on left ventricular end-diastolic and end-systolic volume, without significantly improving left ventricular or right ventricular functional parameters compared to placebo after 26 weeks.

Gov registration: NCT03087773.

Keywords: Echocardiography; Empagliflozin; Heart failure; Myocardial function; Myocardial infarction; SGLT2 inhibitors.

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Conflict of interest statement

Declarations. Conflict of interest: HS is on the advisory board and speakers bureau of Boehringer Ingelheim, NovoNordisk, Sanofi-Aventis, Amgen, AstraZeneca, Bayer, Eli Lilly, Kapsch, MSD, and Daiichi Sankyo. DvL is on the advisory board and speaker’s bureau of by Boehringer Ingelheim, Novartis, Sanova, Sanofi, Orion, AstraZeneca, Bayer Recardio, Vaxxinity and Daiichi Sankyo. NS and EK report no conflict of interest related to this study. All other authors report no conflict of interest related to this study. Ethics approval and consent to participate: The EMMY trial was approved by the Ethics committee of the Medical University of Graz, Austria (EK 29–179 ex16/17, EudraCT 2016–004591-22) and registered at ClinicalTrials.gov (NCT03087773). The trial conformed to the 1964 Declaration of Helsinki and adhered to the guidelines of Good Clinical Practice (ICH GCP E6). All study participants provided written consent. Consent for publication: All authors consent for the publication of this study.

Figures

Fig. 1
Fig. 1
Patient disposition. Echocardiographic data for evaluation was available from three major sites: the Medical University of Graz (n = 219), the Hospital Graz II—West (n = 16), and the Hospital Klagenfurt am Woerthersee (n = 78)
Fig. 2
Fig. 2
Changes in echocardiographic parameters by treatment group. a LVEDV: left-ventricular end-diastolic volume, b LVESV: left-ventricular end-systolic volume, c LA-GLS: left-atrial global longitudinal strain, and d RV-GLS: right-ventricular global longitudinal strain
See this image and copyright information in PMC

References

    1. St John Sutton M, Pfeffer MA, Plappert T, Rouleau JL, Moye LA, Dagenais GR et al (1994) Quantitative two-dimensional echocardiographic measurements are major predictors of adverse cardiovascular events after acute myocardial infarction. The protective effects of captopril. Circulation 89(1):68–75. 10.1161/01.cir.89.1.68 - DOI - PubMed
    1. Solomon SD, Skali H, Anavekar NS, Bourgoun M, Barvik S, Ghali JK et al (2005) Changes in ventricular size and function in patients treated with valsartan, captopril, or both after myocardial infarction. Circulation 111(25):3411–3419. 10.1161/CIRCULATIONAHA.104.508093 - DOI - PubMed
    1. Shah AM, Claggett B, Prasad N, Li G, Volquez M, Jering K et al (2022) Impact of sacubitril/valsartan compared with ramipril on cardiac structure and function after acute myocardial infarction: the PARADISE-MI echocardiographic substudy. Circulation 146(14):1067–1081. 10.1161/CIRCULATIONAHA.122.059210 - DOI - PMC - PubMed
    1. Doughty RN, Whalley GA, Walsh HA, Gamble GD, Lopez-Sendon J, Sharpe N et al (2004) Effects of carvedilol on left ventricular remodeling after acute myocardial infarction: the CAPRICORN echo substudy. Circulation 109(2):201–206. 10.1161/01.CIR.0000108928.25690.94 - DOI - PubMed
    1. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Bohm M et al (2021) 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 42(36):3599–3726. 10.1093/eurheartj/ehab368 - DOI - PubMed

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