The role of Sodium Glucose Cotransporter 2 inhibitors in the management of patients with aortic stenosis

The aortic valve is one of the heart valves that controls the blood flow from the heart to the rest of the body. In some people, there can be “wear and tear” of the valve resulting in significant narrowing of the valve with time (termed aortic stenosis). As a result, the heart must work much harder to pump enough blood, through the restricted valve, to the body efficiently. This continuously increased workload on the heart muscle can result in thickening or scarring of the heart muscle. There is currently no medicine to protect the heart muscle, but we want to study a medication called empagliflozin, which is a Sodium Glucose Cotransporter 2 inhibitor (SGLT2i) to see if it protects the heart muscle of patients with aortic stenosis. SGLT2i are already used to treat heart problems such as heart failure, and they have positive effects on the heart muscle. Therefore, the aim of this study is to investigate whether the use of empagliflozin prevents the formation of scar or the abnormal thickening of the heart muscle in patients with aortic stenosis. Using blood tests, advanced imaging techniques that do not involve radiation or cause any harm (such as echocardiography and cardiovascular magnetic resonance), we intend to study their effect on the heart muscle of these patients. For this purpose, we aim to randomly assign patients to either take empagliflozin or not take it, and test their heart function and quality of life (through blood tests, scans and validated questionnaires) at baseline and after 6 months. We want to see if the medication can improve how the heart muscle works, and if it helps to preserve the overall function of the heart.