The aim of this study is to explore the effect of SGLT2i on the levels of cardiac biomarkers, inflammatory and stress markers in Egyptian heart failure patients to provide a better understanding of mechanism that might assist in tailoring treatment strategies in patients with various forms of HF especially in Egyptian population. Also understand how biomarkers may be employed to predict risk in patients receiving SGLT2i or identification of those who may derive the most benefit from SGLT2i in the means of individualized medicine.

Inclusion Criteria:

1. Patients aged more than 18 years old.

2. Patients are with cardiac function was graded as II-IV by the New York Heart Association (NYHA)

3. Patients are on standard therapy for management of HF (according to AHA/ACC/HFSA Guideline for the Management of Heart Failure2022)21 such as:

   • ACEi (angiotensin converting enzyme inhibitor)
   • ARB (angiotensin receptor blocker)
   • ARNI in place of ACEi OR ARB
   • Beta blocker
   • (MRA) Mineralocorticoid receptor antagonists
   • Diuretics as needed.

4. All patients signed the informed consent.

Exclusion Criteria:

1. Patients suffering from conditions like acute CVS illness and severe sepsis that raise inflammatory markers and may lead to cardiac dysfunction as opposed to heart failure.
2. Patients with various cardiac conditions, such as severe congenital heart disease, myocarditis, and valvular heart disease.
3. Female patients during pregnancy or lactation
4. Individuals suffering from a malignant tumor, hyperfunctioning thyroid, multiple organ failure, or significantly reduced kidney function (eGFR <20 mL/min/1.73 m²).
5. Individuals suffering from verbal communication disorders or psychic cognitive impairment.

participants who are candidates for SGLT2i and will be recruited from Cardiology Department, Kafrelshiekh University Hospital.

not yet decided by participant