Ketone body levels and its associations with cardiac markers following an acute myocardial infarction: a post hoc analysis of the EMMY trial
Authors' conclusion
This post hoc analysis showed that SGLT2i increased 3-βOHB levels after AMI compared to placebo. Higher baseline 3-βOHB levels were inversely associated with cardiac function at follow-up, whereas a sustained increase in 3-βOHB levels over time improved these markers. This highlights the importance of investigating ketone body metabolism in different post-MI phases. Although more pronounced effect of 3-βOHB on cardiac markers was observed in the SGLT2i group, further research is required to explore this interaction effect.
Study context
- Population
- Patients after acute MI in the EMMY trial
- Comparison
- Empagliflozin for 26 weeks vs placebo after acute MI
- Primary endpoint
- Change in serum β-hydroxybutyrate (3-βOHB) levels after acute MI
- Follow-up
- 26 weeks
Methodological detailsplacebo-controlled
- Placebo-controlled
Primary result
As reported in the abstract
Empagliflozin
49.3
mean · ± 2.2
Placebo
35.8
mean · ± 1.9
P for interaction < 0.001
Further findings
| Outcome | Empagliflozin | Placebo |
|---|---|---|
| Mean serum 3-βOHB at baseline | mean 46.2 ± 3.0 | mean 51.7 ± 2.7 |
| Mean serum 3-βOHB at 6 weeks | mean 48.8 ± 2.2 | mean 42.0 ± 2.3 |
Association of 3-βOHB with NT-proBNP and E/é ratio
- Baseline and longitudinal 3-βOHB not significantly associated with NT-proBNP and E/é ratio
Association of 3-βOHB with left ventricular ejection fraction (LVEF)
- Baseline 3-βOHB with LVEF (coefficient, 95%CI, p)
- - 0.464, - 0.863;- 0.065, p = 0.023
- Increase in 3-βOHB over time with LVEF
- 0.595, 0.156;1.035, 0.008 (coefficient, CI, p)
Association of 3-βOHB with left ventricle end-systolic volume (LVESV)
- Baseline 3-βOHB with LVESV
- 1.409, 0.186;2.632, 0.024 (coefficient, CI, p)
- Increase in 3-βOHB over time with LVESV (coefficient, CI, p)
- - 2.099, - 3.443;- 0.755, 0.002
Association of 3-βOHB with left ventricle end-diastolic volume (LVEDV)
- Baseline 3-βOHB with LVEDV
- 0.640, - 1.170;- 2.449, 0.488 (coefficient, CI, p)
- Increase in 3-βOHB over time with LVEDV (coefficient, CI, p)
- - 2.406, - 4.341;- 0.472, 0.015
Empagliflozin modification of 3-βOHB association with cardiac markers · particularly at 26 weeks
- LVEF
- P for interaction = 0.090
- LVESV
- P for interaction = 0.134
- LVEDV
- P for interaction = 0.168
- Not statistically significant
Original publication
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