Dr Adriaan Voors Explains Potential Decongestive Benefits of Empagliflozin

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Adriaan Voors, MD, discusses possible mechanisms of action of empagliflozin that produce such beneficial results among patients with heart failure, in an interview about the EMPULSE trial prior to this year’s American Heart Association Scientific Sessions.

These findings arising from the EMPULSE trial show that patients with heart failure were decongested, because not only did N-terminal pro–brain natriuretic peptide levels decrease, but so did the clinical signs and symptoms of congestion. Patients actually got rid of fluid, Adriaan Voors, MD, professor of cardiology and director of the Heart Failure Clinic, University Medical Center Groningen, the Netherlands, said in an interview conducted prior to this year’s American Heart Association Scientific Sessions.

Transcript

What about the mechanism of action of empagliflozin makes it especially beneficial to patients with acute heart failure?

That’s the most difficult question that you can pose to me. Nobody knows, because there's multiple mechanisms possibly related to the effects of empagliflozin. Like with so many other drugs that we've used before, we thought we knew how the drug worked, and after a few years, we learned more and we thought, “Oh, it’s a completely different mode of action.” Then, even if we know the mode of action of the drug, we still don't know whether that has caused the beneficial effects. Now, in this setting, it was particularly interesting to see that there was hemo concentration, there was a decrease in NT-proBNP [N-terminal pro–brain natriuretic peptide], there was a decrease in clinical signs and symptoms of congestion, there was weight loss. All 4 point toward the same direction: that patients were actually decongested and got rid of fluid. So, the SGLT2 inhibitor might have contributed to the effect, but you hear my careful wording, because we cannot be sure.