Improvement of Heart Failure with Empagliflozin in a Patient with Diabetes Mellitus and Ischemic Cardiomyopathy

A 54-year-old man with diabetes mellitus and ischemic cardiomyopathy due to old myocardial infarction of triple vessel disease admitted to our hospital because of worsening heart failure (HF). Although he was previously treated with coronary artery bypass graft (CABG) and cardiac resynchronization therapy (CRT) in addition to optimal medical therapy, he was non-responder of CRT and had experienced repetitive HF hospitalizations. Infusion of catecholamine transiently improved his HF condition, which did not last after tapering of the treatment. Recently, empagliflozin, one of the sodium-glucose cotransporter 2 (SGLT-2) inhibitors, has been reported to exert the beneficial effects for diabetic patients with cardiovascular diseases. Thus, we decided to treat him with it. Administration of empagliflozin (10 mg) dramatically improved his HF condition within 1 month, including 6 kg weight loss (81 to 75 kg), 7% reduction in cardiothoracic ratio on chest X-ray (56 to 49%), and more than 100 pg/ml BNP reduction (347 to 211 pg/ml) without any adverse effects. Moreover, addition of empagliflozin enabled us to reduce a dose of furosemide, which is known to cause adverse cardiovascular effects when used at high-dose use. We here report a case of intractable HF associated with diabetes mellitus and ischemic cardiomyopathy despite CABG, CRT and optimal medical therapy, where empagliflozin dramatically improved the HF condition.