Heart failure & cardiomyopathiesSecondary analysis
Anaemia predicts iron homoeostasis dysregulation and modulates the response to empagliflozin in heart failure with reduced ejection fraction: the EMPATROPISM-FE trial
- Post hoc analysis of the EMPATROPISM-FE randomised trial
- placebo-controlled
Authors' conclusion
Dysregulated cellular iron uptake/availability may be a shared mechanism in myocardial structural/functional impairment, reduced exercise capacity, and restricted haematopoiesis in heart failure, which are worse in patients with anaemia, and improve with empagliflozin. Empagliflozin increases MIC and decreases norepinephrine.
Study context
- Population
- Patients with HFrEF in the EMPATROPISM-FE study24 with anaemia
- Participants
- 80 patients
- Comparison
- Empagliflozin vs placebo, by anaemia status
Primary result
As reported in the abstract
Baseline: anaemia vs no anaemia · baseline
- Anaemia prevalence
- 24/80 (30%)
- Anaemia: higher T2* (lower myocardial iron content (MIC))
- P < .001
- Anaemia: lower VO2max
- P = .024
- Anaemia: lower hepcidin
- P = .017
- Anaemia: higher erythropoietin
- P = .040
- Anaemia: higher norepinephrine
- P = .016
Further findings
Correlates of lower MIC across subgroups · baseline
- Higher left ventricular (LV) volumes
- P < 0.01
- Higher norepinephrine
- P < 0.001
- Lower LV ejection fraction (LVEF)
- P < 0.01
- Lower VO2max
- P < 0.001
- Lower haemoglobin/haematocrit
- P < 0.001
- Poor associations with laboratory iron markers (LIM)
- all P > .10
Effects of empagliflozin at 6 months
- Empagliflozin increased MIC
- P < 0.012
- Improved exercise capacity and activated haematopoiesis
- Changes in LIM and norepinephrine suggested progressive systemic iron depletion and sympatholysis
- Greater LV reverse remodelling in anaemia
Original publication
Anaemia predicts iron homoeostasis dysregulation and modulates the response to empagliflozin in heart failure with reduced ejection fraction: the EMPATROPISM-FE trial. Eur Heart J. Published 5 February 2025. doi:10.1093/eurheartj/ehae917
Summarised from the published abstract; every number is checked against it