Stress Cardiac Magnetic Resonance of Asymptomatic Type 2 Diabetics with Cardiovascular High Risk to Measure Empagliflozin Impact on Myocardial Blood Flow (CATCH-EM)

Prior treatment

• Prior coronary artery bypass grafts
• Previous myocardial infarct
• Contraindication to dual antiplatelet therapy
• Contraindication to empagliflozin or other SGLT2 inhibitors
• Patients currently on empagliflozin or given empagliflozin in the last 6 months
• Planned need for concomitant cardiac surgery or coronary intervention

Other illness

• Angina pectoris or chest discomfort

Lab values

• Renal impairment with eGFR \<45ml/min/1.73m2

Age

• Limited life expectancy \<5 years, for example due to pulmonary disease, cancer or significant hepatic failure

Other

• Coronary artery stenting within 6 months of study enrolment
• Any contraindication for stress CMR testing
• Unable to take empagliflozin
• Refusal or inability to sign an informed consent.
• Potential for non-compliance towards the requirements in the trial protocol (especially the medical treatment) or follow-up visits

• Onset of type 2 diabetes at ≥30yrs old with no history of ketoacidosis
• 40-90yrs old
• Any 2 risk factors which include:
  • Smoking (ie. current or ex-smokers) ii) Dyslipidaemia (defined as low density lipoprotein ≥2.6mmol/L, triglyceride \>1.7mmol/L or decreased high density lipoprotein cholesterol \<1.04mmol/L \[man\] or \<1.29mmol/L \[woman\] or on lipid-lowering agent)(17, 18) iii) Hypertension (ie. systolic blood pressure \>140mmHg or diastolic blood pressure \>90mmHg or patients treated for hypertension) iv) Obesity (using definition adapted for chinese ethnicity, body mass index \>25kg/m2)(19) v) Family history of premature heart disease (defined as 1st degree relative \[ie. parent or sibling\] with development of atherosclerotic cardiovascular disease or cardiovascular related death \<55 years of age in male and \<65 years of age in female)
• HbA1c ≥ 6.5% and \<10.0%