Acute Reno-Cardiac Action of Dapagliflozin In Advanced Heart Failure Patients on Heart Transplant Waiting List

Inclusion Criteria: 1. Patient has signed informed consent form 2. Age ≥ 18 years 3. NYHA class ≥3 4. LVEF ≤ 35% 5. On optimal medical management (OMM) based on current heart failure practice guidelines at maximal tolerated dose for at least 30 days 6. On waiting list for heart transplantation after multidisciplinary Heart Team decision, with anticipated access to heart transplant ≥ 6 months Exclusion Criteria: 1. Priority patient on waiting list for heart transplantation 2. Etiology of heart failure due to or associated with uncorrected thyroid disease, obstructive cardiomyopathy, pericardial disease, amyloidosis or restrictive cardiomyopathy 3. Inotrope dependent, existence of ongoing mechanical circulatory support 4. Current acute decompensated HF or hospitalization due to decompensated HF \<30 days prior to the enrolment 5. History of any organ transplant or prior implantation of a ventricular assistance device (VAD) or similar device, or implantation expected after randomization 6. Presence of an active, uncontrolled infection 7. Any recent interventional procedure likely to improve symptoms and heart failure status (coronary revascularization, percutaneous mitral valve intervention, cardiac resynchronization therapy) \< 60 days 8. Glomerular filtration rate \< 30 ml/min/1.73 m2, according to CKD-EPI formula 9. Unstable or rapidly progressing renal disease 10. Patients with severe hepatic impairment (Child-Pugh class C) 11. Chronic treatment with dapagliflozin or other SGLT2 inhibitors 12. Patient with known history of severe drug intolerance to dapagliflozin or any excipients of the dapagliflozin (galactose, lactase) 13. Type 1 diabetes mellitus 14. Any surgical or medical condition which might significantly alter the absorption, distribution, metabolism, or extraction of study drug at investigators' discretion 15. Participation in another clinical interventional trial 16. Any condition other than heart failure that could limit survival to less than 24 months 17. Positive pregnancy test if of childbearing potential or refusal to use adequate contraception or women breast-feeding 18. Patients with any legal protection measure 19. Patients without any health coverage 20. Psychiatric disease/disorder, irreversible cognitive dysfunction or psychological issues that are likely to impair compliance