Individual Approach to Prescribing Sodium-Glucose Co-Transporter 2 Inhibitors in Patients with Hypertrophic Cardiomyopathy

Keywords: SGLT2 inhibitors, LVOT obstruction, diabetes mellitus, heart failure, congenital heart diseases, myosin, methods of echocardiography


Hypertrophic cardiomyopathy (HCM) is a common hereditary disease of the myocardium. Sodium-glucose co-transporter 2 inhibitors are recognized as first-line drugs for the treatment of heart failure, but at the moment there is little known about their use in HCM.

The aim. To assess the possibility of using an acute test with empagliflozin in patients with HCM with echocardiographic assessment of left ventricular outflow tract (LVOT) obstruction.

Materials and methods. Twenty-six non-obstructive HCM patients were examined. All the patients underwent an acute test with sodium-glucose co-transporter 2 inhibitor using 10 mg of empagliflozin and echocardiographic examination before and 3 hours after administration. Twenty-four patients were included in the further analysis (2 patients were excluded due to arrhythmia). The patients were divided into two groups: group 1 included subjects with an increase in LVOT pressure after empagliflozin (12 patients), group 2 included those without an increase in the gradient (12 patients).

Results. During the acute test, an increase in LVOT gradient occurred in 12 patients, and in 6 patients the gradient increased significantly and reached more than 30 mm Hg. The indicator at rest in patients before the test was 11.2 (10.1-19), after the test it was 12.45 (8.9-17) mm Hg (p = 0.042). The indicator at the height of the Valsalva test also increased from 15 (11-29) to 15.45 (10.4-33) mm Hg (p=0.29). Comparative analysis of clinical and echocardiographic data did not show significant difference between the groups.

Conclusions. In some patients with HCM without signs of overt or latent obstruction at the baseline, a significant increase in LVOT pressure was noted after acute test with empagliflozin. Conducting an acute test in patients with HCM is appropriate to determine the possibility of the development of LVOT obstruction while taking the drug.


  1. Authors/Task Force members; Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P, et al. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(39):2733-2779.
  2. Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, et al. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020;142(25):e558-e631.
  3. Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, et al.; ESC Scientific Document Group. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J. 2023;44(37):3503-3626.
  4. Melas M, Beltsios ET, Adamou A, Koumarelas K, McBride KL. Molecular Diagnosis of Hypertrophic Cardiomyopathy (HCM): In the Heart of Cardiac Disease. J Clin Med. 2022 Dec 28;12(1):225.
  5. Tseluyko VY, Belostotskaya EA. [Genetic basis of hypertrophic cardiomyopathy]. Ukrainian Journal of Cardiology. 2008;(4):118-122. Russian.
  6. Tseluiko VI, Butko OO. [Risk factors of sudden cardiac death in patients with hypertrophic cardiomyopathy]. Cardiac surgery and interventional cardiology. 2012;(2):51-56. Ukrainian. Available from:
  7. McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, et al.; ESC Scientific Document Group. 2023 Focused Update of the 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2023;44(37):3627-3639.
  8. Solomon SD, McMurray JJV, Claggett B, de Boer RA, DeMets D, Hernandez AF, et al.; DELIVER Trial Committees and Investigators. Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction. N Engl J Med. 2022;387(12):1089-1098.
  9. Packer M, Butler J, Zannad F, Filippatos G, Ferreira JP, Pocock SJ, et al. Effect of Empagliflozin on Worsening Heart Failure Events in Patients With Heart Failure and Preserved Ejection Fraction: EMPEROR-Preserved Trial. Circulation. 2021;144(16):1284-1294.
  10. Subramanian M, Sravani V, Krishna SP, Bijjam S, Sunehra C, Yalagudri S, et al. Efficacy of SGLT2 Inhibitors in Patients With Diabetes and Nonobstructive Hypertrophic Cardiomyopathy. Am J Cardiol. 2023;188:80-86.
  11. Goldstein DS, Cheshire WP Jr. Beat-to-beat blood pressure and heart rate responses to the Valsalva maneuver. Clin Auton Res. 2017;27(6):361-367.
How to Cite
Tseluyko, V. Y., Butko, O. O., Kinoshenko, K. Y., & Biletska, V. V. (2024). Individual Approach to Prescribing Sodium-Glucose Co-Transporter 2 Inhibitors in Patients with Hypertrophic Cardiomyopathy. Ukrainian Journal of Cardiovascular Surgery, 32(1), 51-57.