Hemodynamic effects of semaglutide in individuals with heart failure with preserved ejection fraction and obesity: a placebo-controlled randomized clinical trial.

Semaglutide 2.4 mg weekly reduced invasively measured pulmonary artery wedge pressure during exercise by -9.8 mmHg versus +0.9 mmHg with placebo in 81 HFpEF patients with obesity.

• Why it matters: HFpEF symptoms improve with semaglutide, but the hemodynamic mechanism—especially cardiac congestion during exertion—was unclear.
• What they did: In a double-blind, placebo-controlled trial, 81 patients with HFpEF and obesity were randomized to semaglutide or placebo for 52 weeks, with PAWP measured invasively at rest and during low-intensity exercise.
• The result: Compared with placebo, semaglutide lowered resting PAWP (estimated difference -7.1 mmHg) and increased hemodynamic HFpEF remission (53.7% vs 7.4%; odds ratio 14.1), indicating reduced left heart filling pressures and remission linked to treatment.

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