Dapagliflozin and ventilatory control during exercise in heart failure with preserved ejection fraction: the CAMEO-DAPA trial

Heart failure (HF) with preserved ejection fraction (HFpEF) is characterized by exertional intolerance due to symptoms of dyspnoea and fatigue.1 Sodium-glucose cotransporter 2 inhibitors (SGLT2i) improve central haemodynamics, enhance quality of life, and reduce the risk of HF hospitalization or cardiovascular death in patients with HFpEF.2–4 Exercise capacity is typically quantified in HF by the oxygen consumption (VO2) at volitional exhaustion, but patients with HFpEF rarely reach this exercise intensity during activities of daily living. In this context, capacity to engage in low-intensity exercise comfortably may be more strongly correlated with patient-reported health status.5 We investigated the effect of dapagliflozin compared with placebo on metabolic and ventilatory responses to low-intensity exercise in a secondary analysis from CAMEO-DAPA trial (Evaluation of the Cardiac and Metabolic Effects of Dapagliflozin in Heart Failure With Preserved Ejection Fraction).2 After written informed consent, participants underwent blood sampling and invasive haemodynamic cardiopulmonary exercise testing and were then randomized, double-blind, to either dapagliflozin 10 mg once daily or a matching placebo and treated for 24 weeks, after which repeat assessments were performed. Symptomatic adult patients with HF, left ventricular ejection fraction ≥ 50%, and elevated pulmonary artery (PA) wedge pressure (PAWP) during exercise (≥25 mmHg) were included. The study was reviewed and approved by the Mayo Clinic Institutional Review Board.