Background:Stressed blood volume (SBV) is a major determinant of systemic and pulmonary venous pressures which, in turn, determine left and right ventricular fillings and regulates cardiac output via the Frank-Starling mechanism. It is not known whether inhibition of the SGLT2 (sodium–glucose cotransporter-2) favorably affects SBV. We investigated the effect of empagliflozin on estimated SBV in patients with heart failure and reduced ejection fraction compared with placebo.Methods:This was a post hoc analysis of an investigator-initiated, double-blinded, placebo-controlled, randomized trial. Seventy patients were assigned to empagliflozin 10 mg or matching placebo once daily for 12 weeks. Patients underwent right heart catheterization at rest and during exercise at baseline and follow-up. The outcome was change in estimated SBV after 12 weeks of empagliflozin treatment over the full range of exercise, determined using a recently introduced analytical approach based on invasive hemodynamic assessment.Results:Patients with heart failure and reduced ejection fraction, mean age, 57 years and mean ejection fraction 27%, with 47 patients (71%) receiving diuretics were randomized. The effect of empagliflozin on estimated SBV over the full range of exercise loads showed a statistically significant reduction compared with placebo (−198.4 mL [95% CI, −317.4 to −79.3] P=0.001), a 9% decrease. The decrease in estimated SBV by empagliflozin was significantly correlated with the decrease in PCWP (R=−0.33, P<0.0001). The effect of empagliflozin was consistent across subgroup analysis.Conclusions:Empagliflozin treatment significantly reduced SBV compared with placebo after 12 weeks of treatment in patients with stable chronic heart failure and reduced ejection fraction during sub maximal exercise.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03198585.

中文翻译：

---

Empagliflozin 对慢性心力衰竭和射血分数降低患者血容量再分布的影响：来自 Empire HF 随机临床试验的分析

背景：压力血容量 (SBV) 是全身和肺静脉压的主要决定因素，而后者又决定左右心室充盈，并通过 Frank-Starling 机制调节心输出量。目前尚不清楚 SGLT2（钠-葡萄糖协同转运蛋白 2）的抑制是否会对 SBV 产生有利影响。我们研究了与安慰剂相比，empagliflozin 对心力衰竭和射血分数降低患者估计 SBV 的影响。方法：这是一项由研究者发起的、双盲、安慰剂对照、随机试验的事后分析。70 名患者被分配到 empagliflozin 10 mg 或匹配安慰剂组，每天一次，持续 12 周。在基线和随访期间，患者在休息和运动期间接受了右心导管插入术。结果是在 empagliflozin 治疗 12 周后，在整个运动范围内估计 SBV 的变化，这是使用最近引入的基于侵入性血流动力学评估的分析方法确定的。结果：患有心力衰竭和射血分数降低的患者，平均年龄 57 岁和平均射血分数为 27%，其中 47 名患者 (71%) 接受利尿剂被随机分配。与安慰剂相比，empagliflozin 对整个运动负荷范围内估计的 SBV 的影响显示出统计学上显着的降低（-198.4 mL [95% CI，-317.4 至 -79.3] 47 名患者 (71%) 接受利尿剂被随机分配。与安慰剂相比，empagliflozin 对整个运动负荷范围内估计的 SBV 的影响显示出统计学上显着的降低（-198.4 mL [95% CI，-317.4 至 -79.3] 47 名患者 (71%) 接受利尿剂被随机分配。与安慰剂相比，empagliflozin 对整个运动负荷范围内估计的 SBV 的影响显示出统计学上显着的降低（-198.4 mL [95% CI，-317.4 至 -79.3]P = 0.001)，下降 9%。empagliflozin 估计的 SBV 降低与 PCWP 降低显着相关（R =-0.33，P <0.0001）。恩格列净的效果在亚组分析中是一致的。结论：与安慰剂相比，恩格列净治疗在亚最大运动期间稳定的慢性心力衰竭和射血分数降低的患者治疗 12 周后显着降低 SBV。注册：网址：https://www .clinicaltrials.gov；唯一标识符：NCT03198585。