Liver tests, cardiovascular outcomes and effects of empagliflozin in patients with heart failure and preserved ejection fraction: the EMPEROR‐Preserved Trial - Université de Lorraine Access content directly
Journal Articles European Journal of Heart Failure Year : 2023

Liver tests, cardiovascular outcomes and effects of empagliflozin in patients with heart failure and preserved ejection fraction: the EMPEROR‐Preserved Trial

Marcin Krawczyk
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Felix Mahfoud
Elke Schüler
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Abstract

Aim: The prognostic implication of elevated liver tests in heart failure with preserved ejection fraction (HFpEF) is uncertain. This analysis investigates the association of liver markers with heart failure hospitalization (HHF) and cardiovascular death (CVD), and the treatment effect of empagliflozin across the range of liver marker levels. Methods and results: The double-blind, placebo-controlled EMPEROR-Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure with Preserved Ejection Fraction) enrolled 5988 patients with HFpEF (ejection fraction >40%). Patients in New York Heart Association class II-IV and elevated NTpro-BNP were randomized to receive empagliflozin 10 mg daily or placebo in addition to usual therapy. Patients with significant liver disease were excluded. The primary endpoint was time to first adjudicated HHF or CVD. We explored the association of liver function abnormalities with heart failure outcomes in patients on placebo, the effects of empagliflozin on liver tests and the treatment effects of empagliflozin on HF outcomes across categories of liver laboratory values. High alkaline phosphatase (ALP) (trend p<0.0001), low albumin (trend p <0.0001) and high bilirubin (p=0.02) were associated with poorer outcomes for HHF or CVD, while high AST was not, and high ALT was associated with better outcomes. Empagliflozin had no significant effects on liver tests compared to placebo except for albumin which was significantly increased. The treatment effect of empagliflozin on outcomes was not modified by liver tests. Conclusion: Abnormalities of liver function tests are associated differently with heart failure outcomes. Salutary effects of empagliflozin on liver tests were not observed although albumin increased. The treatment benefits of empagliflozin were not affected by baseline values of liver parameters.
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hal-04123514 , version 1 (09-06-2023)

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Michael Böhm, Javed Butler, Marcin Krawczyk, Felix Mahfoud, Bernhard Haring, et al.. Liver tests, cardiovascular outcomes and effects of empagliflozin in patients with heart failure and preserved ejection fraction: the EMPEROR‐Preserved Trial. European Journal of Heart Failure, 2023, 25 (8), pp.1375-1383. ⟨10.1002/ejhf.2922⟩. ⟨hal-04123514⟩
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