Henagliflozin and Heart Scarring in Non-Obstructive Hypertrophic Cardiomyopathy

Trial details

Who runs it

Shanghai East Hospital

Trial code

NCT07294495

Record updated

19 December 2025

Original description

his is a single-center, randomized, double-blind, placebo-controlled clinical trial designed to evaluate the effect of Henagliflozin (an SGLT2 inhibitor) on myocardial fibrosis burden in patients with non-obstructive hypertrophic cardiomyopathy (nHCM). The study will use 68 68 Ga/ 18 18 F-FAPI PET/CMR imaging to quantitatively assess changes in active fibroblast activity after 6 months of treatment. A total of 150 eligible adult patients with nHCM (FAPI-positive at baseline, NYHA class I-III) will be enrolled and randomized in a 1:1 ratio to either the Henagliflozin group (10 mg once daily) or the placebo group for a 6-month treatment period. The primary endpoint is the change in myocardial FAPI target-to-background ratio (ΔTBR) at 6 months. Secondary endpoints include changes in FAPI SUVmax, FAPI burden percentage (FAV%), cardiac structure and function parameters, 6-minute walk distance, NYHA classification, NT-proBNP levels, and quality-of-life scores. Exploratory analyses will assess clinical events over 12 months, such as heart failure hospitalization, atrial fibrillation, ventricular arrhythmias, and cardiovascular death. The study employs stratified block randomization based on baseline FAPI burden, central randomization and blinding via IWRS, independent core laboratory imaging evaluation, and an intention-to-treat analytical approach. It aims to provide early evidence for the anti-fibrotic effect of Henagliflozin in nHCM and to validate FAPI-PET/CMR as an imaging biomarker for fibrosis activity.Read full original descriptionShow less

A Randomized, Double-Blind, Placebo-Controlled Clinical Trial to Evaluate the Effect of Henagliflozin on Myocardial Fibrosis Burden in Patients With Non-Obstructive Hypertrophic Cardiomyopathy Using 68Ga/18F-FAPI PET/CMR

his is a single-center, randomized, double-blind, placebo-controlled clinical trial designed to evaluate the effect of Henagliflozin (an SGLT2 inhibitor) on myocardial fibrosis burden in patients with non-obstructive hypertrophic cardiomyopathy (nHCM). The study will use 68 68 Ga/ 18 18 F-FAPI PET/CMR imaging to quantitatively assess changes in active fibroblast activity after 6 months of treatment. A total of 150 eligible adult patients with nHCM (FAPI-positive at baseline, NYHA class I-III) will be enrolled and randomized in a 1:1 ratio to either the Henagliflozin group (10 mg once daily) or the placebo group for a 6-month treatment period. The primary endpoint is the change in myocardial FAPI target-to-background ratio (ΔTBR) at 6 months. Secondary endpoints include changes in FAPI SUVmax, FAPI burden percentage (FAV%), cardiac structure and function parameters, 6-minute walk distance, NYHA classification, NT-proBNP levels, and quality-of-life scores. Exploratory analyses will assess clinical events over 12 months, such as heart failure hospitalization, atrial fibrillation, ventricular arrhythmias, and cardiovascular death. The study employs stratified block randomization based on baseline FAPI burden, central randomization and blinding via IWRS, independent core laboratory imaging evaluation, and an intention-to-treat analytical approach. It aims to provide early evidence for the anti-fibrotic effect of Henagliflozin in nHCM and to validate FAPI-PET/CMR as an imaging biomarker for fibrosis activity.

Inclusion: Aged 18 years or older, regardless of gender; Meets the diagnostic criteria for non-obstructive hypertrophic cardiomyopathy (HCM):; Confirmed diagnosis of HCM by cardiac magnetic resonance (CMR) or echocardiography (left ventricular wall thickness ≥15 mm, or ≥13 mm in the presence of a family history of HCM); Exclusion of patients in whom left ventricular hypertrophy is primarily attributable to hypertensive heart disease, as assessed by a cardiology specialist based on clinical and imaging evidence; Exclusion of other identifiable causes of secondary myocardial hypertrophy (e.g., valvular heart disease, storage cardiomyopathies); Left ventricular outflow tract (LVOT) gradient <30 mmHg at rest or under provocation, as assessed by echocardiography or CMR; Willing to undergo FAPI PET/CMR examination and complete imaging evaluations; Baseline FAPI PET/CMR scan shows positive FAPI uptake: myocardial FAPI target-to-background ratio (TBR) ≥1.3, using the ascending aorta blood pool as the background reference; Capable of understanding and signing the informed consent form, and agrees to participate in the study, accept randomization, and comply with follow-up visits; New York Heart Association (NYHA) functional class I-III.

Exclusion: Concurrent other severe systemic disease with a life expectancy of less than 1 year; Coexistence of other identifiable causes of myocardial hypertrophy, including:; Predominant or persistent hypertensive heart disease; Severe aortic stenosis or other significant valvular heart disease; Infiltrative or storage cardiomyopathies (e.g., Fabry disease, amyloidosis); Ischemic heart disease (e.g., severe coronary artery disease); Overt decompensated heart failure or NYHA functional class IV; Unstable, serious arrhythmias (e.g., sustained ventricular tachycardia, recent cardioversion for atrial fibrillation); Recent (within 3 months) cardiac surgery or interventional procedure; History of allergy to the study drug or any contraindication to its use; Any other condition deemed by the investigator to make the subject unsuitable for participation; ALT or AST >3 times the upper limit of normal (ULN), OR total bilirubin (Tbil) >2 times ULN, OR ketonuria/ketonemia, OR eGFR <30 mL/min/1.73m², OR creatine kinase (CK) >3 times ULN; Significant left ventricular outflow tract obstruction (resting or provoked LVOT pressure gradient ≥30 mmHg); Pregnant or breastfeeding women.

ClinicalTrials.gov NCT07294495