Key result
SGLT2i reduce LV mass by ~3.4 g and improve E/e' in T2D with Stage A/B HF.
Why the study?
Do SGLT2 inhibitors improve cardiac structure and function in patients with type 2 diabetes and Stage A and B heart failure?
Meta-Analysis (n=773)
Yes
Do SGLT2 inhibitors improve cardiac structure and function in patients with type 2 diabetes and Stage A and B heart failure?
Effect estimate: MD -3.37 g (95% CI -5.42 to -1.33)
p-value: p=0.001
SGLT2 inhibitors significantly reduce LV mass and improve filling pressures in patients with type 2 diabetes and Stage A or B heart failure, suggesting favorable early myocardial modification.
Supports SGLT2 inhibitor use to regress LV hypertrophy in diabetes; meta-analysis strengthens evidence for structural benefits.
BACKGROUND: Stage A and B heart failure (HF) in type 2 diabetes (T2DM) represents a critical window for prevention. Although SGLT2 inhibitors (SGLT2i) are recommended for early HF risk reduction, their direct structural effects on pre-symptomatic myocardium remain insufficiently characterized in this population. METHODS: MEDLINE, Cochrane Central, Scopus, and ClinicalTrials.gov were searched from inception to February 2026 for studies comparing SGLT2i with placebo in T2DM with Stage A and B HF. Risk of bias was assessed with RoB 2.0. R (version4.5.2) was used to analyse outcomes. Certainty of evidence was assessed using GRADE. RESULTS: Ten trials (n = 773) showed significant reductions in LV mass (-3.37 g), LVMI (-1.84 g/m²) and E/e' (-0.81). SGLT2i improved weight, BMI, HbA1c, and systolic blood pressure. Safety outcomes were favorable, with no diabetic ketoacidosis reported. CONCLUSIONS: SGLT2i use was associated with a significant reduction in LV mass and improvements in filling pressures, suggesting a favorable modification of underlying myocardium in Stage A and B HF. These changes likely reflect hemodynamic unloading and mass regression rather than immediate functional recovery.
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Khanna et al. (2026) conducted a meta-analysis in Stage A and B heart failure with type 2 diabetes (n=773). SGLT2 inhibitors vs. Placebo or standard care was evaluated on Left ventricular (LV) mass (MD -3.37 g, 95% CI -5.42 to -1.33, p=0.001). SGLT2 inhibitors significantly reduced left ventricular mass by 3.37 g and improved E/e' ratio by 0.81 in patients with type 2 diabetes and Stage A or B heart failure.
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