Empagliflozin's role in reducing ventricular repolarization heterogeneity: insights into cardiovascular mortality decline from the EMPATHY-HEART trial.

BACKGROUND: The incidence of myocardial infarction (MI) and sudden cardiac death (SCD) is significantly higher in individuals with Type 2 Diabetes Mellitus (T2DM) than in the general population. Strategies for the prevention of fatal arrhythmias are often insufficient, highlighting the need for additional non-invasive diagnostic tools. The T-wave heterogeneity (TWH) index measures variations in ventricular repolarization and has emerged as a promising predictor for severe ventricular arrhythmias. Although the EMPA-REG trial reported reduced cardiovascular mortality with empagliflozin, the underlying mechanisms remain unclear. This study investigates the potential of empagliflozin in mitigating cardiac electrical instability in patients with T2DM and coronary heart disease (CHD) by examining changes in TWH. METHODS: Participants were adult outpatients with T2DM and CHD who exhibited TWH > 80 µV at baseline. They received a 25 mg daily dose of empagliflozin and were evaluated clinically including electrocardiogram (ECG) measurements at baseline and after 4 weeks. TWH was computed from leads V4, V5, and V6 using a validated technique. The primary study outcome was a significant (p < 0.05) change in TWH following empagliflozin administration. RESULTS: An initial review of 6,000 medical records pinpointed 800 patients for TWH evaluation. Of these, 412 exhibited TWH above 80 µV, with 97 completing clinical assessments and 90 meeting the criteria for high cardiovascular risk enrollment. Empagliflozin adherence exceeded 80%, resulting in notable reductions in blood pressure without affecting heart rate. Side effects were generally mild, with 13.3% experiencing Level 1 hypoglycemia, alongside infrequent urinary and genital infections. The treatment consistently reduced mean TWH from 116 to 103 µV (p = 0.01). CONCLUSIONS: The EMPATHY-HEART trial preliminarily suggests that empagliflozin decreases heterogeneity in ventricular repolarization among patients with T2DM and CHD. This reduction in TWH may provide insight into the mechanism behind the decreased cardiovascular mortality observed in previous trials, potentially offering a therapeutic pathway to mitigate the risk of severe arrhythmias in this population. TRIAL REGISTRATION: NCT: 04117763.

Idade, tabagismo, hipertensão arterial, altura e sexo feminino são determinantes de envelhecimento vascular avaliados pela segunda derivada da fotopletismografia digital / Age, tabagism, arterial hypertension, height and feminine sex are determinants of vascular aging evaluated by the second derivative of the digital photoplethysmogram

Avaliar os fatores de risco cardiovascular (RCV) determinantes dosíndices de função arterial obtidos pela segunda derivada da fotopletismografia digital (SDPTG) em uma população de funcionários de uma instituição de ensino privado da cidade de São Paulo. MÉTODOS: Foram obtidos dados antropométricos e clínicos, medidas de pressão arterial (PA) com aparelho automático Microlife em 238 ndivíduos de 23 a 72 anos (média 40,1 ± 9), 105 mulheres / 133 homens. A SDPTG foi registrada automaticamente pelo dispositivo ...

To evaluate the cardiovascular risk (CR) determinants of the arterialfunction indices obtained by the second derivative photopletysmogram (SDPTG) in a agentpopulation from a private teaching institution of São Paulo. Methods: antropometric and clinicaldata, arterial pressure (AP) by na automatic device Microlife were obtained from 238 individualsfrom 28 to 72 years (mean 40,1 ± 9), 105 women / 133 men. The SDPTG was automaticallyregistered by the Dynapulse device through its sensor placed on the 2nd finger of the right hand...

Misuse of antithrombotic therapy in atrial fibrillation patients: frequent, pervasive and persistent.

PURPOSE: To assess the use of antithrombotic therapy among atrial fibrillation (AF) patients in a Brazilian University Heart Hospital (InCor). METHODS AND RESULTS: In a cross-sectional study we analyzed the charts of all patients treated at InCor in five separate days of 2002 (Phase 1). To assess the impact of admission to a cardiology hospital, a follow-up of the AF patients selected in Phase 1 was carried out after 1 year (Phase 2). The prevalence of AF in the 3,764 assessed charts was 8.0% (301 patients). In Phase 1, antiplatelets were prescribed to 21.2% and anticoagulant therapy (ACT) to 46.5% of AF patients; in Phase 2, to 19.9 and 57.8%, respectively. Thus, 32.2% (Phase 1) and 22.2% (Phase 2) of AF patients were not receiving any antithrombotic drug. Among AF patients with previous ischemic stroke (17.6%), only 49% (Phase 1) and 60.4% (Phase 2) were receiving ACT. As many as 34 and 22.6%, respectively, were not receiving any antithrombotic drug. After follow-up, a new acute embolic event was documented in 5.6% of patients, 17% died. CONCLUSIONS: Anticoagulation is underused in AF patients and neither the fact of being treated by cardiologists in a University Hospital, nor the learning time-window of 1 year seemed to improve the antithrombotic care significantly.