Question explored with the scientific record
Conversation so far
- 1 Jaudiance and heart function
- 2 Does it help improve cardiac output after stent surgery
- 3 Can Jardiance help with ejection fraction
Answered on this page ↓
Can Jardiance help with ejection fraction
Jardiance raises ejection fraction only modestly, and mostly in people whose hearts were already failing. It is not a pumping-power drug.
In the small real-world study of 31 people with reduced ejection fraction, average LVEF rose from about 33% to about 39% over 12 months on an SGLT2 inhibitor [1]. That is a nonrandomized cohort with no control group, so some of that gain could have come from standard therapy or from the passage of time. The randomized EmDia trial found something different: in people with diabetes and mostly normal ejection fraction, left ventricular systolic function was largely unchanged after empagliflozin [3]. The diastolic (filling) side improved instead [3].
In mice with pressure-overload failure, empagliflozin blunted the drop in ejection fraction [4]. Animals are not people.
| Outcome | What changed | Study type |
|---|---|---|
| Ejection fraction, reduced EF | ~33% to ~39% at 12 months | Uncontrolled cohort, n=31 [1] |
| Ejection fraction, mostly normal EF | "Largely unchanged" | Randomized trial [3] |
| Diastolic function (filling) | Improved | Randomized trial [3] |
| Death or HF hospitalization | 19.4% vs 24.7% | Randomized trial [2][5] |
Here is the honest framing. The benefit that matters is fewer hospitalizations and less cardiovascular death, and that is real in reduced-ejection-fraction heart failure [2][5]. The ejection-fraction bump is a secondary finding in an uncontrolled cohort [1]. Nobody in this evidence ran a randomized trial with ejection fraction as the primary endpoint in a general heart-failure population, so the pumping-power claim rides mostly on the animal work and the uncontrolled human cohort.
My call: expect a small ejection-fraction gain at best, and treat the hard outcomes (hospitalization, death) as the reason to take it, not the echo number. Confidence: moderate on the hard outcomes, low on the ejection-fraction effect in humans.
Sources used 5
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Impact of Gliflozins on Right Heart Remodeling in Italian Patients with Type 2 Diabetes and Heart Failure: Results from the GLISCAR Real-World Study
A 12-month real-world study in 31 Italian patients with type 2 diabetes and heart failure with reduced ejection fraction (HFrEF) treated with SGLT2 inhibitors (empagliflozin or dapagliflozin) showed significant improvements in right-ventricular remodeling and pulmonary hemodynam…
DOI: 10.3390/ph18081200 -
P003. An Evidence Based Quality Improvement Project of the Impact of a Nurse Practitioner Led Heart Failure, Self-Care Focused, Patient Education on Healthcare Related Quality of Life
This study investigates the effects of empagliflozin on cardiovascular and renal outcomes in patients with heart failure, demonstrating a significant reduction in the risk of cardiovascular death and hospitalization for heart failure compared to placebo.
DOI: 10.1016/j.hrtlng.2021.03.058 -
Effects of empagliflozin on left ventricular diastolic function in addition to usual care in individuals with type 2 diabetes mellitus—results from the randomized, double-blind, placebo-controlled EmDia trial
In a randomized, double-blind trial (EmDia) in adults with type 2 diabetes and elevated LV filling pressures, adding empagliflozin 10 mg daily to usual care significantly improved left ventricular diastolic function (E/e´) over 12 weeks compared with placebo, with concurrent fav…
DOI: 10.1007/s00392-023-02164-w -
Direct Cardiac Actions of Sodium-Glucose Cotransporter 2 Inhibition Improve Mitochondrial Function and Attenuate Oxidative Stress in Pressure Overload-Induced Heart Failure
In a non-diabetic mouse model of pressure overload-induced heart failure, four weeks of empagliflozin improved mitochondrial function and reduced oxidative stress through direct cardiac effects, attenuating remodeling and improving cardiac function without changing blood glucose…
DOI: 10.3389/fcvm.2022.859253 -
Efficacy of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors in Heart Failure Management: A Narrative Review
This narrative review reports pooled randomized-trial estimates that SGLT2 inhibitors reduce heart failure hospitalizations and cardiovascular mortality overall, with greater benefit in HFrEF and limited HFpEF mortality benefit.
DOI: 10.61919/jhrr.v4i3.1573