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Michael Gotzmann, Pauline Henk, Ulrik Stervbo-Kristensen, Arturo Blazquez-Navarro, Andreas Mügge, Nina Babel, Timm Westhoff

• \(\bf Background:\) The inhibition of sodium-glucose co-transporter 2 (SGLT-2) has been shown to be beneficial in the treatment of diabetic and non-diabetic patients with heart failure. The underlying mechanisms are incompletely understood. The present prospective study investigates for the first time the effect of empagliflozin on various soluble markers of inflammation in patients with reduced ejection fraction (HFrEF). \(\bf Methods:\) We included 50 inpatients with HFrEF and diabetes mellitus type 2. A total of 25 patients received a therapy with the SGLT-2-inhibitor empagliflozin in addition to standard medication; the other 25 patients did not receive empagliflozin and were considered the control group. Quality of life, functional status and soluble immunological parameters in serum were assessed at baseline and after 3 months. \(\bf Results:\) The baseline characteristics of both groups revealed no significant differences. Patients on empagliflozin demonstrated a significant improvement in the Minnesota living with heart failure questionnaire (baseline 44.2 \(\pm\) 20.2 vs. 24 \(\pm\) 17.7; \(\it p\) < 0.001), in distance in the 6-min walk test (baseline 343 \(\pm\) 145 m vs. 450 \(\pm\) 115 m; \(\it p\) < 0.001) and in soluble interleukin-6 level (baseline 21.7 \(\pm\) 21.8 pg/mL vs. 13.7 \(\pm\) 15.8 pg/mL; \(\it p\) = 0.008). There was no significant change of these or other parameters in the control group (\(\it p\) > 0.05 each). \(\bf Conclusions:\) The empagliflozin-induced improvement of quality of life and functional capacity in patients with HFrEF and type 2 diabetes mellitus is accompanied by a substantial reduction of interleukin-6 levels. Thus, anti-inflammatory effects may contribute to the benefits of SGLT-2-inhibitors in heart failure.