The exact mechanism of cardiovascular benefit from SGLT2i continues to be the source of
further research. The investigators hypothesize that heart failure patients with LVADs
will similarly benefit from the SGLT2i-associated natriuresis and diuresis, which in turn
reduces preload. This is further associated with reduced heart failure readmissions and
right ventricular failure. Additionally, the animal models indicating reduced cardiac
work and remodeling in this population may benefit these patients as one of the goals of
LVAD implantation is to reduce cardiac energy expenditure and promote remodeling and
recovery in these patients.
This is a prospective, randomized controlled study to assess cardiac benefit of SGLT2i in
40 consecutive patients with heart failure undergoing LVAD implantation. After routine
LVAD implantation, patients will be randomized 1:1 to one of two routine care arms:
management with an SGLT2i [empagliflozin 10 milligram (mg) daily or dapagliflozin 10 mg
daily, based on formulary coverage] or no SGLT2i. The patient's treating physician will
be able to override randomization assignment if they determine that the assignment is not
in the patient's best interest. SGLT2i management (if applicable) and follow-up care will
be dictated by routine care. Data will be collected from the subject's medical record for
6 months.
