Metabolic Response to the Initiation of Heart Failure Therapy

Exclusion Criteria

• •Previous SGLT2 inhibitor therapy or i.v., iron therapy in past 3 months (for SGLT2i arm)
• •Previous sGC stimulator (for sGC arm), or previous ARNI (for ARNI arm), or previous SGLT2i, sGC or ARNI for control group.
• •Coronary artery bypass grafting (CABG), cardiac resynchronisation therapy (CRT), STEMI, valve replacement, in past 3 months, or planned within next 3 months
• •Blood loss needing transfusion in past 3 months
• •Clinical instability (including HF hospitalization) in the past 1 month
• •Myelodysplasia, chronic hemolysis, erythropoetin therapy
• •Systemic inflammatory condition (lupus, rheumatoid arthritis...) or infection
• •Uncontrolled cancer
• •Chronic kidney disease (CKD) grade 4-5
• •Severe anemia with Hgb less than 90 g/L
• •No chronic exposure to hypoxia (severe chronic obstructive pulmonary disease, obstructive sleep apnoea, long-term oxygen therapy)
• •History of SGLT2i allergy or intolerance
• •Repeated genitourinary infection