Baseline characteristics of patients with heart failure with preserved ejection fraction in the EMPEROR‐Preserved trial

• Published in: European journal of heart failure Vol. 22; no. 12; pp. 2383 - 2392
• Main Authors: Anker, Stefan D., Butler, Javed, Filippatos, Gerasimos, Shahzeb Khan, Muhammad, Ferreira, João Pedro, Bocchi, Edimar, Böhm, Michael, Brunner‐La Rocca, Hans Pieter, Choi, Dong‐Ju, Chopra, Vijay, Chuquiure, Eduardo, Giannetti, Nadia, Gomez‐Mesa, Juan Esteban, Janssens, Stefan, Januzzi, James L., Gonzalez‐Juanatey, Jose R., Merkely, Bela, Nicholls, Stephen J., Perrone, Sergio V., Piña, Ileana L., Ponikowski, Piotr, Senni, Michele, Seronde, Marie‐France, Sim, David, Spinar, Jindrich, Squire, Iain, Taddei, Stefano, Tsutsui, Hiroyuki, Verma, Subodh, Vinereanu, Dragos, Zhang, Jian, Jamal, Waheed, Schnaidt, Sven, Schnee, Janet M., Brueckmann, Martina, Pocock, Stuart J., Zannad, Faiez, Packer, Milton
• Format: Journal Article
• Language: English
• Published: Oxford, UK John Wiley & Sons, Ltd 01-12-2020; European Society of Cardiology (Wiley)
• Subjects: Aged; Aged, 80 and over; Benzhydryl Compounds - therapeutic use; Biomarkers - blood; Cardiology and cardiovascular system; Cardiovascular Agents - therapeutic use; Diabetes Mellitus, Type 2 - drug therapy; Double-Blind Method; Empagliflozin; Female; Glucosides - therapeutic use; Heart Failure - blood; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - physiopathology; Heart failure with preserved ejection fraction; Human health and pathology; Humans; Life Sciences; Male; Middle Aged; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Sodium–glucose co‐transporter 2 inhibitors; Stroke Volume; Heart failure with preserved ejection fraction; Empagliflozin; Sodium-glucose co-transporter 2 inhibitors
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1002/ejhf.2064

ABSTRACT
Aims
EMPEROR‐Preserved is an ongoing trial evaluating the effect of empagliflozin in patients with heart failure with preserved ejection fraction (HFpEF). This report describes the baseline characteristics of the EMPEROR‐Preserved cohort and compares them with patients enrolled in prior HFpEF trials.
Methods and results
EMPEROR‐Preserved is a phase III randomized, international, double‐blind, parallel‐group, placebo‐controlled trial in which 5988 symptomatic HFpEF patients [left ventricular ejection fraction (LVEF) >40%] with and without type 2 diabetes mellitus (T2DM) have been enrolled. Patients were required to have elevated N‐terminal pro B‐type
natriuretic peptide (NT‐proBNP) concentrations (i.e. >300 pg/mL in patients without and >900 pg/mL in patients with atrial fibrillation) along with evidence of structural changes in the heart or documented history of heart failure hospitalization. Among patients enrolled from various regions (45% Europe, 11% Asia, 25% Latin America, 12% North America), the mean age was 72 ± 9 years, 45% were women. Almost all patients had New York Heart Association class II or III symptoms (99.6%), and 23% had prior heart failure hospitalization within 12 months. Thirty‐three percent of the patients had baseline LVEF of 41–50%. The mean LVEF (54 ± 9%) was slightly lower while the median NT‐proBNP [974 (499–1731) pg/mL] was higher compared with previous HFpEF trials. Presence of comorbidities such as diabetes (49%) and chronic kidney disease (50%) were common. The majority of the patients were on angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor–neprilysin inhibitors (80%) and beta‐blockers (86%), and 37% of patients were on mineralocorticoid receptor antagonists.
Conclusion
When compared with prior trials in HFpEF, the EMPEROR‐Preserved cohort has a somewhat higher burden of comorbidities, lower LVEF, higher median NT‐proBNP and greater use of mineralocorticoid receptor antagonists at baseline. Results of the EMPEROR‐Preserved trial will be available in 2021.
Baseline characteristics of patients with heart failure with preserved ejection (HFpEF) in the EMPEROR‐Preserved trial. ACEi, angiotensin‐converting enzyme inhibitor; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor–neprilysin inhibitor; CKD, chronic kidney disease; CV, cardiovascular; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid receptor antagonist; NT‐proBNP, N‐terminal pro B‐type natriuretic peptide; NYHA, New York Heart Association; T2DM, type 2 diabetes mellitus.