Pharmacological Reduction of Right Ventricular Enlargement

Inclusion Criteria: * 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 syndrom…