Ertugliflozin Significantly Reduces Functional Mitral Regurgitation in Heart Failure patients : Study

Functional mitral regurgitation (MR) is a common complication in patients with heart failure (HF), contributing to significant morbidity and mortality despite standard medical therapy. The EFFORT trial was a multicenter, double-blind, randomized study examining whether ertugliflozin could improve MR in patients with HF, New York Heart Association functional class II or III, and an ejection fraction between 35% and 50%.

A total of 128 patients were randomly assigned to receive either ertugliflozin or placebo, in addition to guideline-directed medical therapy for HF. The primary endpoint was a change in the effective regurgitant orifice area of functional MR from baseline to the 12-month follow-up. Secondary endpoints included changes in regurgitant volume, left ventricular (LV) volume indices, left atrial volume index, LV global longitudinal strain, and NT-proBNP (N-terminal pro-B-type natriuretic peptide).

The key findings of the study were as follows:

• The treatment groups were well-matched in baseline characteristics, with mean age 66±11 years and 61% male participants.

• The decrease in the effective regurgitant orifice area was significantly greater in the ertugliflozin group compared to the placebo group (−0.05±0.06 versus 0.03±0.12 cm2; P<0.001).

• Ertugliflozin was associated with a reduction in regurgitant volume by 11.2 mL (95% CI, −16.1 to −6.3; P=0.009), a decrease in the left atrial volume index by 6.0 mL/m2 (95% CI, −12.16 to 0.15; P=0.005), and improved LV global longitudinal strain by 1.44% (95% CI, −2.42% to −0.46%; P=0.004).

• There were no significant between-group differences in LV volume indices, ejection fraction, or NT-proBNP levels.

• Serious adverse events occurred in 1.6% of ertugliflozin group participants versus 9.2% of the placebo group (P=0.12).

Ertugliflozin demonstrated significant improvement in left ventricular global longitudinal strain and left atrial remodeling, as well as a reduction in functional MR in patients with HF. Sodium-glucose cotransporter 2 inhibitors like ertugliflozin may offer a novel therapeutic approach for patients with functional MR.

Reference:

Duk-Hyun Kang, MD, PhD, Sung-Ji Park, MD, PhD, Sung-Hee Shin, MD, PhD, In-Chang Hwang, MD, Yeonyee Elizabeth Yoon, MD, PhD, Hyung-Kwan Kim, MD, PhD, Mijin Kim, MD, PhD, Min-Seok Kim, MD, PhD, Sung-Cheol Yun, PhD, Jong-Min Song, MD, PhD, Seok-Min Kang, MD, PhD Ertugliflozin for Functional Mitral Regurgitation Associated With Heart Failure: EFFORT TrialCirculation. 2024;149:00–00. DOI: 10.1161/CIRCULATIONAHA.124.069144