Short-term Effects of Dapagliflozin on Maximal Functional Capacity in Heart Failure with Reduced Ejection Fraction (DAPA-VO2 ): A Randomized Clinical Trial

AIMS

This study aimed to evaluate the effect of dapagliflozin on 1 and 3-month maximal functional capacity in patients with stable heart failure with reduced ejection fraction (HFrEF).

METHODS AND RESULTS

In this multicenter, randomized, double-blinded clinical trial, 90 stable patients with HFrEF were randomly assigned to receive either dapagliflozin (n=45) or placebo (n=45) (http://clinicaltrials.gov identifier: NCT04197635). The primary outcome was a change in peak oxygen consumption (peakVO₂ ) at 1 and 3-month. Secondary endpoints were changes at 1 and 3-month in the distance walked in 6 minutes (6MWT), quality of life (Minnesota Living with Heart Failure Questionnaire -MLHFQ-), and echocardiographic parameters (diastolic function, left chambers volumes, and left ventricular ejection fraction). We used linear mixed regression analysis to compare endpoints changes. Estimates were adjusted for multiple comparisons. The mean age was 67.1 ± 10.7 years, 63 (76.7%) were men, 29 (32.2%) had type-2 diabetes, and 80 (89.9%) were on NYHA II. The baseline means of peakVO₂ , 6MWT and MLHFQ were 13.2±3.5 mL/kg/min, 363±110 meters, and 23.1±16.2, respectively. The median (p25%-p75%) of N-terminal pro-brain natriuretic peptide was 1221 pg/ml (889-2100). Most patients were on treatment with sacubitril/valsartan (88.9%), beta-blockers (91.1%), and aldosterone receptor antagonists (74.4%). PeakVO₂ significantly increased in patients on treatment with dapagliflozin (1-month: +Δ 1.09 mL/kg/min, CI 95%=0.14-2.04; p=0.021 and 3-month: +Δ 1.06 mL/kg/min, CI 95%=0.07-2.04; p=0.032). Similar positive findings were found when evaluating changes from baseline. We did not find significant differences in secondary endpoints.

CONCLUSIONS

Among patients with stable HFrEF, dapagliflozin resulted in a significant improvement in peakVO₂ at 1 and 3-month.