Myocardial blush grade: a determinant of left ventricular ejection fraction and adverse outcomes in STEMI

2020 ◽  
pp. 003693302094126 ◽  
Author(s):  
Adeel-ur Rehman ◽  
Jahanzeb Malik ◽  
Nismat Javed ◽  
Imran Iftikhar ◽  
Hamid Sharif
Keyword(s):  
Ejection Fraction ◽  
Statistical Tests ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Percentage Increase ◽  
Ventricular Ejection Fraction ◽  
Diabetes Status ◽  
Myocardial Blush Grade

Background and aims Despite restoration of blood flow, subtle microvascular obstruction can occur. This obstruction can be graded using myocardial blush grade. We aimed to investigate the role of myocardial blush grade in ejection fraction and adverse outcomes, after percutaneous intervention. Methods A prospective, observational study was conducted at our institute with a calculated sample size. Variables such as age, gender, and ejection fraction were noted before the intervention. The patients were followed for 3 months to determine the outcomes. The data was analyzed using IBM SPSS software version 26.0. P-value of less than 0.05 was considered significant for the statistical tests. Results There were 74 male and 36 female participants in the study. The mean age was 52.20 ± 10.02 years. The most common adverse outcome was heart failure (18%). There was a significant Pearson’s correlation between myocardial blush grade and improvement in ejection fraction (p < 0.05). Improvement in myocardial blush grade was significantly related to a decrease in adverse outcomes (p < 0.05). Regression analysis proved myocardial blush grade and diabetes status as independent predictors of percentage increase in ejection fraction (p < 0.05). Conclusion High myocardial blush grade is one of the independent predictors of better outcomes in ST-elevation myocardial infarction.

Клиническое значение результатов исследования DAPA HF (Dapagliflozin and prevention of adverse-outcomes in heart failure) для пациентов и врачей. Консенсус совета Экспертов

2021 ◽  
Vol 1 (223) ◽  
pp. 2-14
Author(s):  
Gulmira Alipova ◽  
◽  
Anna Bazarova ◽  
Nazira Bazarova ◽  
Rimma Bazarbekova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Cardiovascular Death ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Persistent Symptoms

The article presents the results of the DAPA-HF study - evaluating the efficacy of dapagliflozin, used at a dose of 10 mg once a day, in addition to the standard treatment for patients with chronic heart failure with reduced left ventricular ejection fraction, compared to placebo. An analysis of current clinical recommendations related to this issue was carried out, the results of recent clinical studies and metaanalyses conducted were highlighted. Based on the results of the study, the need is postulated to optimize drug therapy of this category to patients with persistent symptoms of heart failure, despite standard therapy, with the addition of dapagliflozin to reduce the risk of cardiovascular death and hospitalizations for heart failure, improve the course of the disease. Keywords: chronic heart failure, dapagliflozin, low ejection fraction, effects of type 2 sodium-glucose co transporter inhibitors, diabetes mellitus.

scholarly journals Influence of polypharmacy on patients with heart failure with preserved ejection fraction: a retrospective analysis on adverse outcomes in the TOPCAT trial

2020 ◽  
Vol 71 (702) ◽  
pp. e62-e70
Author(s):  
Yuzhong Wu ◽  
Wengen Zhu ◽  
Xin He ◽  
Ruicong Xue ◽  
Weihao Liang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Retrospective Analysis ◽  
Heart Function ◽  
Left Ventricular ◽  
Adverse Outcomes ◽  
Left Ventricular Ejection ◽  
Controlled Study ◽  
Preserved Ejection Fraction ◽  
Ventricular Ejection Fraction

BackgroundPolypharmacy is common in heart failure (HF), whereas its effect on adverse outcomes in patients with HF with preserved ejection fraction (HFpEF) is unclear.AimTo evaluate the prevalence, prognostic impacts, and predictors of polypharmacy in HFpEF patients.Design and settingA retrospective analysis performed on patients in the Americas region (including the US, Canada, Argentina, and Brazil) with symptomatic HF and a left ventricular ejection fraction ≥45% in the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial, an international, randomised, double-blind, placebo-controlled study conducted during 2006–2013 in six countries.MethodPatients were categorised into four groups: controls (<5 medications), polypharmacy (5–9 medications), hyperpolypharmacy, (10–14 medications), and super hyperpolypharmacy (≥15 medications). The outcomes and predictors in all groups were assessed.ResultsOf 1761 participants, the median age was 72 years; 37.5% were polypharmacy, 35.9% were hyperpolypharmacy, and 19.6% were super hyperpolypharmacy, leaving 7.0% having a low medication burden. In multivariable regression models, three experimental groups with a high medication burden were all associated with a reduction in all-cause death, but increased risks of HF hospitalisation and all-cause hospitalisation. Furthermore, several comorbidities (dyslipidemia, thyroid diseases, diabetes mellitus, and chronic obstructive pulmonary disease), a history of angina pectoris, diastolic blood pressure <80 mmHg, and worse heart function (the New York Heart Association functional classification level III and IV) at baseline were independently associated with a high medication burden among patients with HFpEF.ConclusionA high prevalence of high medication burden at baseline was reported in patients with HFpEF. The high medication burden might increase the risk of hospital readmission, but not the mortality.

scholarly journals Sequential cardiovascular magnetic resonance assessment of left ventricular ejection fraction for prediction of subsequent events in a large multicenter STEMI registry

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
J Gavara ◽  
V Marcos-Garces ◽  
C Rios-Navarro ◽  
MP Lopez-Lereu ◽  
JV Monmeneu ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Ventricular Ejection ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ventricular Ejection Fraction

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – EU funding. Main funding source(s): This work was supported by “Instituto de Salud Carlos III” and “Fondos Europeos de Desarrollo Regional FEDER” Background. Cardiovascular magnetic resonance (CMR) is the best tool for left ventricular ejection fraction (LVEF) quantification, but as yet the prognostic value of sequential LVEF assessment for major adverse cardiac event (MACE) prediction after ST-segment elevation myocardial infarction (STEMI) is uncertain. Purpose. We explored the prognostic impact of sequential assessment of CMR-derived LVEF after STEMI to predict subsequent MACE. Methods. We recruited 1036 STEMI patients in a large multicenter registry. LVEF (reduced [r]: &lt;40%; mid-range [mr]: 40-49%; preserved [p]: ≥50%) was sequentially quantified by CMR at 1 week and after &gt;3 months of follow-up. MACE was regarded as cardiovascular death or re-admission for acute heart failure after follow-up CMR. Results. During a 5.7-year mean follow-up, 82 MACE (8%) were registered. The MACE rate was higher only in patients with LVEF &lt; 40% at follow-up CMR (r-LVEF 22%, mr-LVEF 7%, p-LVEF 6%; p-value &lt; 0.001). Based on LVEF dynamics from 1-week to follow-up CMR, incidence of MACE was 5% for sustained LVEF³40% (n = 783), 13% for improved LVEF (from &lt;40 to ³40%, n = 96), 21% for worsened LVEF (from ³40% to &lt;40%, n = 34) and 22% for sustained LVEF &lt;40% (n = 100), p-value &lt; 0.001. Using a Markov approach that considered all studies performed, transitions towards improved LVEF predominated and only r-LVEF (at any time assessed) was significantly related to higher incidence of subsequent MACE. Conclusions. LVEF constitutes a pivotal CMR index for simple and dynamic post-STEMI risk stratification. Detection of reduced LVEF (&lt;40%) by CMR at any time during follow-up identifies a small subset of patients at high risk of subsequent events.

P1027Left atrial hypertension invasively measured during pulmonary vein isolation as a predictor of atrial fibrillation recurrence

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Manfrin ◽  
G Mugnai ◽  
G B Chierchia ◽  
C Bilato ◽  
W G Rauhe
Keyword(s):  
Atrial Fibrillation ◽  
Multivariate Analysis ◽  
Ejection Fraction ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Drug Resistant ◽  
Ventricular Ejection Fraction

Abstract Background The clinical role of left atrial hypertension (LAH) in patients with atrial fibrillation (AF) and its role as predictor in those undergoing pulmonary vein (PV) isolation is still unknown. Purpose The aim of the present study was to analyse the prevalence of LAH in patients with nonvalvular AF and preserved left ventricular ejection fraction having undergone PV isolation and its implication for AF catheter ablation. Methods Consecutive patients with drug resistant AF who underwent PV isolation at San Maurizio Regional Hospital of Bolzano (Italy) as index procedure were retrospectively included in this analysis. Left atrial hypertension was defined as the LA mean pressure &gt;15 mm Hg. Results A total of 98 consecutive patients (71 males, 72%; mean age 60.3 ± 8.4 years) with drug resistant, non valvular AF and preserved LV ejection fraction having undergone index PV isolation procedure were included in the analysis. Eleven patients (11%) underwent radiofrequency ablation and 87 (89%) cryoballoon ablation. The mean LA pressure was 10.7 ± 4.5 mmHg; LAH occurred in 24 (24%) patients. At a mean follow up of 14.6 ± 7.1 months (median 14 months), the success rate without antiarrhythmic therapy was 71.4% (70/98; considering the blanking period). On multivariate analysis, LAH remained the only independent predictor of definitive AF recurrence (HR 3.02, 1.36-6.72, p = 0.007). Conclusion Left atrial hypertension was found in 24% of patients undergoing PV isolation and was found to be significantly related to both early and late AF recurrences. Univariate and multivariate Cox regressi Univariate analysis Multivariate analysis Early Recurrence (during BP) HR 95%CI P value HR 95%CI P value Age (years) 1.06 1.02-1.10 0.005 1.05 1.00-1.09 0.03 LA volume (ml/m2) 1.02 1.00-1.05 0.04 1.02 1.00-1.05 0.05 LA hypertension 2.46 1.32-4.57 0.004 1.97 1.03-3.79 0.04 Recurrence after the BP HR 95%CI P value HR 95%CI P value Age (years) 1.05 1.00-1.11 0.04 1.04 0.98-1.09 0.15 LA hypertension 3.51 1.62-7.60 0.001 3.02 1.36-6.72 0.007 BP recurrence 1.83 0.84-3.99 0.13 AF atrial fibrillation. BMI: body mass index. LA: left atrium. CAD: coronary artery disease. BP: blanking period. HR: hazard ratio. CI: confidence intervals.

scholarly journals Evaluation of Left ventricular systolic function by Myocardial Deformation Imaging in Hypertensive patients with Preserved Left Ventricular Ejection Fraction

2021 ◽  
Vol 18 (2) ◽  
pp. 15-19
Author(s):  
Bishow Raj Baral ◽  
Arun Maskey ◽  
Rabi Malla ◽  
Sujeeb Rajbhandari ◽  
Krishna Chandra Adhikari ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Imaging Technique ◽  
Strain Imaging ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ventricular Ejection Fraction ◽  
Left Ventricular Strain ◽  
Hypertensive Patients ◽  
Healthy Control

Background and Aims:  Hypertension being one of the commonest non communicable diseases is major risk factor leading to premature death.1 With development of, the left ventricular strain imaging technique by echocardiography the consequences of hypertension may be identified and intervene earlier. The aim of study was to show abnormalities in cardiac function in the form of left ventricular strain imaging in hypertensive patients with preserved Ejection fraction. Methods: This  was a cross-sectional, comparative and observational study done in Shahid Gangalal National Heart Centre and National Academy of Medical Sciences, Bir Hospital Kathmandu which included hypertensive patients with baseline examination including a medical history, clinical examination and a standardized trans thoracic echocardiography and strain imaging examination and the findings were compared among age and sex frequency matched 82 healthy adults in 1 : 2 ratio. The independent paired t test was used for the comparative statistical analysis. Results: We enrolled 240 patients in this study, 158 were hypertensive (mean age 48.5 ±6.1 years with 50.6 % female) and 82 healthy control (mean age 45.62 ±6.3 years with 51.2% female). There was no significant difference in conventional echocardiographic parameters between two groups except for left ventricular mass index and relative wall thickness that was highest in hypertensive group (p value of <0.001). The hypertensive population has lower mean global longitudinal strain (GLS) value of -18.6% ± 2.06 SD compared to the healthy control population with mean of -19.5% ± 1.1 SD (p value of <0.001). Conclusion: Hypertensive patients with preserved left ventricular ejection fraction have subclinical left ventricular dysfunction revealed by GLS imaging technique.

Abstract 14958: Global Longitudinal Strain is a Superior Predictor of All-cause Mortality Compared to Left Ventricular Ejection Fraction in Male Patients with Heart Failure and Without Atrial Fibrillation

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Morten Sengeløv ◽  
Tor Biering-Sørensen ◽  
Peter Godsk Jørgensen ◽  
Niels Eske Bruun ◽  
Thomas Fritz-Hansen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Left Ventricular Ejection Fraction ◽  
Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ventricular Ejection Fraction ◽  
Global Strain ◽  
Echocardiographic Parameters

Object: Myocardial strain deformation analysis (global strain) may be superior to left ventricular ejection fraction (LVEF) in predicting all-cause mortality in patients with heart failure. Methods: In this retrospective study transthoracic echocardiographic examinations were retrieved from Gentofte Hospital heart failure clinic’s database in 1061 patients. The echocardiographic images were subsequently analyzed and conventional echocardiographic parameters and strain data were obtained. Results: During a median follow-up of 40 months 177 (16.7 %) patient died. Mean LVEF was 23.7 % and mean global strain was -8.12.884 (83.3%) were patients alive at follow-up and mean LVEF was 28.2 % while mean global strain was -9.86 %. The risk of dying increased with decreasing tertile of global strain being approximately three times higher for the patients in the lower tertile compared to the highest tertile (1. tertile vs 3. tertile HR: 3.38 95% CI: 2.3 [[Unable to Display Character: &#8211;]] 5.1), p-value: 0.001. Many of the conventional echocardiographic parameters proved to be predictors of mortality. Global strain remained an independent predictor of mortality in cox proportional-hazards models after adjusting for age, gender, BMI, total cholesterol, heart rate, atrial fibrillation, non-independent diabetes mellitus and conventional echocardiographic parameters (p-value: 0.014, 95% CI: 1.04 [[Unable to Display Character: &#8211;]] 1.37) while ejection fraction proved to be insignificant adjusted for aforementioned characteristics (p-value: 0.81, 95% CI: 0.96 [[Unable to Display Character: &#8211;]] 1.05 Atrial fibrillation modified the relationship between GLS and mortality (p for interaction = 0.023). HR 1.08 (CI 0.97 to 1.19, p=0.150) and HR 1.22 (CI 1.15 to 1.29, p<0.001) per 10 % decrease in GLS for patients with and without atrial fibrillation, respectively. Gender also modified the relationship between mean GLS and mortality (p for interaction = 0.047); HR 1.23 (CI 1.16 to 1.30, p<0.001) and HR 1.09 (CI 0.99 to 1.20, p=0.083) per 10 % decrease in GLS for men and women, respectively. Conclusion: In male patients with systolic heart failure and without atrial fibrillation global strain is an independent predictor of all-cause mortality. Furthermore, global strain proved to be a superior prognosticator when compared to left ventricular ejection fraction.

High-Dose Immunosuppressive Therapy (HDIT) for Severe Systemic Sclerosis (SSc): Long-Term Survivors Show Continued Improvement of Function and Skin with Stability in the Lungs.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 149-149 ◽  
Author(s):  
Peter McSweeney ◽  
Daniel Furst ◽  
Leslie Crofford ◽  
Kevin McDonagh ◽  
Keith Sullivan ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Disease Progression ◽  
Immunosuppressive Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ventricular Ejection Fraction ◽  
Skin Score

Abstract Objective To evaluate long-term outcomes after HDIT and transplantation of autologous CD34+ hematopoietic progenitor cells in severe SSc. Methods: Eligibility required early (<= 4 years) diffuse SSc (modified Rodnan skin score [mRSS] of > 15) together with involvement of lungs, heart or kidneys (estimated median 5 year survival <= 50%). Pulmonary SSc was the most frequent indication for study inclusion. PBSC were obtained by G-CSF mobilization and CD34-selected with a Baxter Isolex 300i system. HDIT included total body irradiation 800 Gy (with lung shielding of the last 25 pts), cyclophosphamide 120 mg/kg and equine anti-thymocyte globulin 90 mg/kg. Follow-up included annual history and physical exams with complete workup for visceral involvement and questionnaires of overall function. Results: Of 33 pts (median mRSS = 30) follow-up includes 25 patients at one year, 19 pts at two years, 13 pts at three years and 5 pts at four years. Progression was defined as further loss of organ function or use of immunosuppressive therapy after HDIT. Ten pts died of which 5 were due to disease progression and 5 to transplant complications. Estimated 3-year overall and progression-free survivals are 79% (95% CI 65–93%) and 52% (95% CI 33–72%), respectively. Three late deaths from progression occurred at 1343, 1511 and 1801 days after HDIT. Four pts are alive with progressive disease. At 1 and 3 years after HDIT there were significant improvements in skin score and function (Table) with lung function indices overall remaining stable. Small increases in serum creatinine and decreases in the left ventricular ejection fraction were found. Five pts developed renal insufficiency and 2 required dialysis. Conclusions: HDIT appears to be a promising therapy for high-risk SSc pts but limitations include transplant toxicities and disease progression in some pts. To more clearly define the role of HDIT in severe SSc, a NIH-supported randomized multicenter study has been initiated in North America to compare HDIT against 12 doses of monthly intravenous cyclophosphamide at 750 mg/m2. Changes at 1 and 3 years after HDIT* Baseline 1 year p value 3 years p value *Values are means and mean changes from baseline. HAQ - health assessment questionnaire; DLCO- carbon monoxide diffusing capacity; FVC-forced vital capacity Skin (mRSS) 30.3 (n=33) −14.8 (n=24) p<0.0001 −23.3 (n=10) p<0.0001 HAQ (function) 1.84 (n=28) −1.06 (n=21) p<0.0001 −1.34 (n=10) p<0.0001 DLCO adj (%) 60.7 (n=33) −5.96 (n=25) p=0.01 −3 (n=13) p=0.56 FVC (%) 71.6 (n=33) +3.44 (n=25) p=0.02 +3.07 (n=13) p=0.05 Se. Creatinine (mg/dL) 0.75 (n=33) +0.30 (n=23) p=0.11 +0.15 (n=13) p=0.05 Ejection Fraction (%) 62.4 (n=30) −2.3 (n=18) p=0.16 −2.3 (n=7) p= 0.06

P2470The prognostic importance and inter-relationship of systolic and diastolic tissue Doppler velocities in heart failure patients with reduced ejection fraction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Sengelov ◽  
P G Jorgensen ◽  
N E Bruun ◽  
T Fritz-Hansen ◽  
F J Olsen ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Function ◽  
Tissue Doppler ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
P Value ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Systolic And Diastolic Function ◽  
Relationship Of

Abstract Background Tissue Doppler imaging (TDI) can be used to evaluate both the systolic and diastolic function in patients with heart failure with reduced ejection fraction (HFrEF). However, previous studies have shown important inter-relationship between these measures in other patient populations. Purpose To investigate the prognostic importance and inter-relationship of systolic and diastolic TDI measures in HFrEF. Methods Conventional echocardiographic measurements together with peak longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities from all 6 myocardial walls were obtained from 1065 HFrEF patients. Outcome was all-cause mortality. Results Mean age was 67 years, 74% were male and mean left ventricular ejection fraction was 27%. During a median follow-up period of 40 months, 177 (16.6%) patients died. In univariable analyses, both s' and a' were associated with mortality (p<0.001), but e' was not (p>0.05). Patients were therefore stratified into high/low groups by the mean value of s' and a' respectively. The prognostic value of s' was significantly modified by a' (p for interaction 0.035). In patients with low s', low a' was associated with an increased risk of dying; HR 1.31 (CI: 1.17–1.55, P=0.001) per 1 cm/s decrease. Patients with both impaired systolic and diastolic function as assessed by low s' and a' had over 3 times greater risk of dying compared to having both high measures of s' and a' (HR 3.39, CI: 2.1–5.1, p<0.001) (figure). Having combined impaired systolic and diastolic function as assessed by low s' and a' remained an independent predictor of mortality even after multivariable adjustment for age, gender, body mass index, mean arterial pressure, ischemic cardiomyopathy, pacemaker, heart rate, total cholesterol, diabetes and conventional echocardiographic measures (HR 1.78 (CI: 1.04–3.04, p=0.035) (table)). Uni- and multivariable Cox regressions Variable Univariable model (95% CI) Multivariable model* HR (95% CI) P value HR (95% CI) P value High s' and high a' (n=386) Ref Ref High s' and low a' (n=113) 1.48 (1.07–4.03) 0.24 1.36 (0.69–2.70) 0.37 Low s' and high a' (n=156) 2.26 (1.34–3.81) 0.002 1.55 (0.86–2.78) 0.14 Low s' and low a' (n=262) 3.29 (2.43–5.75) <0.001 1.78 (1.04–3.04) 0.035 *Multivariable model adjusted for age, gender, body mass index, mean arterial pressure, ischemic cardiomyopathy, pacemaker, heart rate, total cholesterol, diabetes, left ventricular ejection fraction, left ventricular mass index, and deceleration time. Kaplan-Meier curves depicting survival Conclusion A pattern of combined low systolic and diastolic performance as assessed by s' and a' is a significant marker of adverse prognosis for patients with HFrEF, independent of conventional echocardiographic parameters. Acknowledgement/Funding None

scholarly journals Effect of Empagliflozin on Cardiovascular and Renal Outcomes in Patients With Heart Failure by Baseline Diabetes Status - Results from the EMPEROR-Reduced Trial

Circulation ◽  
2020 ◽  
Author(s):  
Stefan D. Anker ◽  
Javed Butler ◽  
Gerasimos Filippatos ◽  
Muhammad Shahzeb Khan ◽  
Nikolaus Marx ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Primary Outcome ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Renal Outcomes ◽  
Diabetes Status ◽  
Patients With Heart Failure

Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve outcomes in patients with heart failure with reduced ejection fraction, but additional information is needed about whether glycemic status influences the magnitude of their benefits on heart failure and renal events. Methods: Patients with class II-IV heart failure and a left ventricular ejection fraction ≤40% were randomized to receive empagliflozin (10 mg daily) or placebo in addition to recommended therapy. We prespecified a comparison of the effect of empagliflozin in patients with and without diabetes. Results: Of the 3730 patients enrolled, 1856 (50%) had diabetes, 1268 (34%) had prediabetes (HbA1c 5.7-6.4%), and 606 (16%) had normoglycemia (HbA1c <5.7%). The risks of the primary outcome (cardiovascular death or hospitalization for heart failure), total hospitalizations for heart failure, and adverse renal outcomes were higher in patients with diabetes, but were similar between patients with prediabetes and normoglycemia. Empagliflozin reduced the risk of the primary outcome in patients with and without diabetes (hazard ratio 0.72 [95% CI 0.60-0.87] and 0.78 [95% CI 0.64-0.97], respectively, interaction P =0.57). Patients with and without diabetes also did not differ with respect to the effect of empagliflozin on total hospitalizations for heart failure, on the decline in estimated glomerular filtration rate over time, and on the risk of serious adverse renal outcomes. Among these endpoints, the effects of the drug did not differ in patients with prediabetes or normoglycemia. When analyzed as a continuous variable, baseline HbA1c did not significantly modify the benefits of empagliflozin on the primary outcome (P-interaction=0.40). Empagliflozin did not lower HbA1c in patients with prediabetes or normoglycemia and was not associated with increased risk of hypoglycemia. Conclusions: In the EMPEROR-Reduced trial, empagliflozin significantly improved cardiovascular and renal outcomes in patients with heart failure and a reduced ejection fraction, independent of baseline diabetes status and across the continuum of HbA1c.

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