Sotagliflozin in HFpEF Without Diabetes: Insights from the SOTA-P-CARDIA Trial

Explore findings from the SOTA-P-CARDIA trial evaluating sotagliflozin, a dual SGLT1/2 inhibitor, in patients with heart failure with preserved ejection fraction (HFpEF) without diabetes. This single-center, randomized, placebo-controlled mechanistic study assessed changes in cardiac structure using cardiac MRI over 6 months. The primary endpoint—change in left ventricular mass—demonstrated regression of adverse remodeling with sotagliflozin compared with placebo. Secondary outcomes included improvements in 6-minute walk distance and Kansas City Cardiomyopathy Questionnaire (KCCQ) quality-of-life scores. A prespecified sub-analysis further examined adipose tissue distribution and identified a selective reduction in epicardial adipose tissue, without significant changes in visceral or subcutaneous fat. Because epicardial adipose tissue is metabolically active and closely interacts with the myocardium, these findings contribute to understanding potential mechanisms underlying therapeutic effects in HFpEF.