Pharmacological Reduction of Right Ventricular Enlargement

• Patients must agree to the study protocol and provide written informed consent
• Outpatients ≥ 20 years of age, male or female

• Patients with severe functional tricuspid regurgitation

  • TR whose vena contracta ≥0.7cm or central jet area > 10 square cm and which lasted > 6 months under medical treatment
  • LV ejection fraction ≥ 50%
• Dyspnea of NYHA functional class II or III

Exclusion Criteria:

• History of hypersensitivity or allergy to the study drugs, drugs of similar chemical classes, as well as known or suspected contraindications to the study drug
• Current use or prior use of a SGLT-2 inhibitor or combined SGLT-1 and 2 inhibitor
• Significant left-sided valve disease
• Left ventricular ejection fraction \<40%
• Marked bradycardia (\<50 beats/min) or 2nd or 3rd degree AVB, sinus node dysfunction
• Severe pulmonary hypertension: TR Vmax >4m/s at screening (including Cor pulmonale)
• Medical history of hospitalization within 6 weeks
• Current acute decompensated heart failure or dyspnea of NYHA functional class IV
• Symptomatic hypotension and/or a SBP \< 90 mmHg at screening Estimated GFR \< 30 mL/min/1.73 square m
• History of ketoacidosis, Type 1 diabetes
• Evidence of hepatic disease as determined by any one of the following: AST or ALT values exceeding 2 x upper limit of normal (ULN) at screening visit (Visit 0), history of hepatic encephalopathy, history of esophageal varices, or history of portocaval shunt.
• Acute coronary syndrome, stroke, severe peripheral artery disease or major CV surgery or PCI within 3 months
• History of severe pulmonary disease (asthma, COPD with bronchial hypersensitivity)
• Secondary hypertension such as pheochromocyotoma
• Acute pulmonary thromboembolism
• Variant angina, vocal cord edema, severe allergic rhinitis
• Women of child-bearing potential, defined as all women physiologically capable of becoming pregnant, unless they are using a barrier method plus a hormonal method
• Pregnant or nursing (lactating) women

• Contraindication for MRI

  • Presence of pacemaker or ICD, implanted metallic objects, claustrophobia
  • Severe beat-to-beat variation
• Galactose intolerance, Lapp lactose deficiency, glucose-galactose malabsorption
• Any clinically significant abnormality identified at the screening visit, physical examination, laboratory tests, or electrocardiogram which, in the judgment of the investigator, would preclude safe completion of the study