Sodium-Glucose Cotransporter 2 Inhibitors in Heart Failure with Preserved Ejection Fraction: Rationale for and Practical Use of a Successful Therapy.

r antagonists, renin–angiotensin–aldosterone system inhibitors and angiotensin receptor neprilysin inhibitor (ARNI) might be used for patients with mildly reduced left ventricular ejection fraction ( HFmrEF; 41–49%), but with a IIB class of recommendation.[ 1 ] Indeed, the PARAGON-HF trial recently showed a trend towards better outcomes in HFpEF patients treated with sacubitril/valsartan (an ARNI) compared to valsartan, especially in the lower end of the left ventricular ejection fraction (LVEF) spectrum, in women, in patients recently hospitalised for HF, and in those with higher high sensitivity troponin values at baseline.[ 3 – 7 ] However, while the Food and Drug Administration has approved sacubitril/valsartan use in patients with ‘below normal’ LVEF, the European Medicines Agency has not.

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