SGLT2 inhibitors significantly reduced mean pulmonary artery pressure at rest in patients with heart failure (MD -1.41 mmHg; 95% CI -2.80 to -0.01; p=0.05).
Systematic Review (n=346)
Do SGLT2 inhibitors reduce mean pulmonary artery pressure and pulmonary artery systolic pressure in patients with heart failure?
SGLT2 inhibitors demonstrate beneficial effects on pulmonary hemodynamics in heart failure patients, significantly reducing resting mean pulmonary artery pressure.
Estimación del efecto: MD -1.41 mmHg (95% CI -2.80 to -0.01)
valor p: p=0.05
Background Heart failure is a major global health burden associated with high morbidity and mortality. Elevated pulmonary artery pressures (PAP) are linked to worse outcomes in heart failure patients. Sodium–glucose cotransporter 2 (SGLT2) inhibitors, initially developed for diabetes, have demonstrated cardiovascular benefits, but their specific effects on pulmonary hemodynamics remain unclear. Methods This systematic review analyzed randomized controlled trials and observational cohort studies evaluating the effects of SGLT2 inhibitors on mean pulmonary artery pressure (mPAP) and pulmonary artery systolic pressure (PASP) in heart failure patients. A comprehensive search of PubMed, Embase, Cochrane Library, and Scopus databases was conducted until August 2024. Studies were appraised using PRISMA and AMSTAR guidelines, the Cochrane bias tool, and the Newcastle–Ottawa Scale. Hypothesis SGLT2 inhibitors reduce PAPs in heart failure patients, leading to beneficial pulmonary hemodynamic effects. Results Six studies (four RCTs and two observational; n = 346) were included. At rest, pooled analysis of three trials showed a significant reduction in mPAP (MD −1.41 mmHg; 95% CI −2.80 to −0.01; p = 0.05; I 2 = 12 % ). During exercise, two studies demonstrated a nonsignificant reduction in mPAP (MD −3.12 mmHg; 95% CI −7.60 to 1.36; p = 0.17; I 2 = 54 % ). For PASP, pooled analysis of four studies suggested a nonsignificant reduction (MD −6.72 mmHg; 95% CI −14.98 to 1.54; p = 0.11; I 2 = 96 % ), but sensitivity analysis excluding one outlier yielded a significant effect (MD −2.76 mmHg; 95% CI −4.99 to −0.53; p = 0.02; I 2 = 0 % ). Secondary outcomes included significant reductions in PCWP, PADP, and NT‐proBNP. Conclusion SGLT2 inhibitors demonstrate beneficial effects on pulmonary pressures and hemodynamics in patients with heart failure, with consistent trends toward lower mPAP, PASP, and PCWP. Although results are influenced by study heterogeneity, the overall evidence suggests meaningful hemodynamic improvements. Larger, long‐term randomized trials are warranted to clarify subgroup effects (HFrEF vs. HFpEF and dapagliflozin vs. empagliflozin) and establish clinical implications.
Bhandari et al. (Wed,) conducted a systematic review in Heart failure (n=346). SGLT2 inhibitors was evaluated on Mean pulmonary artery pressure (mPAP) at rest (MD -1.41 mmHg, 95% CI -2.80 to -0.01, p=0.05). SGLT2 inhibitors significantly reduced mean pulmonary artery pressure at rest in patients with heart failure (MD -1.41 mmHg; 95% CI -2.80 to -0.01; p=0.05).