Key result
SGLT2 inhibitors reduced plasma NT-proBNP levels and improved quality of life scores in T2DM patients with or without chronic heart failure, but did not affect cardiac structural parameters.
Why the study?
Although the benefits of SGLT2i on cardiovascular events have been reported in patients with T2DM with or without HF, the impact of SGLT2i on cardiac remodelling remains to be established.
Does SGLT2i improve cardiac structure, function, NT-proBNP, and KCCQ scores in patients with type 2 diabetes mellitus with or without chronic heart failure?
Meta-Analysis (n=10,978)
Does SGLT2i improve cardiac structure, function, NT-proBNP, and KCCQ scores in patients with type 2 diabetes mellitus with or without chronic heart failure?
Answers are grounded in this paper and cite their sources.
SGLT2 inhibitors improve diastolic function, NT-proBNP levels, and quality of life in patients with T2DM with or without heart failure, and improve LVEF specifically in those with HFrEF, without significantly affecting cardiac structural parameters.
Background Although the benefits of sodium–glucose cotransporter 2 inhibitors (SGLT2i) on cardiovascular events have been reported in patients with type 2 diabetes mellitus (T2DM) with or without heart failure (HF), the impact of SGLT2i on cardiac remodelling remains to be established. Methods We searched the PubMed, Embase, Cochrane Library and Web of Science databases up to November 16th, 2020, for randomized controlled trials reporting the effects of SGLT2i on parameters of cardiac structure, cardiac function, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) level or the Kansas City Cardiomyopathy Questionnaire (KCCQ) score in T2DM patients with or without chronic HF. The effect size was expressed as the mean difference (MD) or standardized mean difference (SMD) and its 95% confidence interval (CI). Subgroup analyses were performed based on the stage A–B or stage C HF population and HF types. Results Compared to placebo or other antidiabetic drugs, SGLT2i showed no significant effects on left ventricular mass index, left ventricular end diastolic volume index, left ventricular end systolic volume index, or left atrial volume index. SGLT2i improved left ventricular ejection fraction only in the subgroup of HF patients with reduced ejection fraction (MD 3.16%, 95% CI 0.11 to 6.22, p = 0.04; I 2 = 0%), and did not affect the global longitudinal strain in the overall analysis including stage A–B HF patients. SGLT2i showed benefits in the E/e’ ratio (MD − 0.45, 95% CI − 0.88 to − 0.03, p = 0.04; I 2 = 0%), plasma NT-proBNP level (SMD − 0.09, 95% CI − 0.16 to − 0.03, p = 0.004; I 2 = 0%), and the KCCQ score (SMD 3.12, 95% CI 0.76 to 5.47, p = 0.01; I 2 = 0%) in the overall population. Conclusion The use of SGLT2i was associated with significant improvements in cardiac diastolic function, plasma NT-proBNP level, and the KCCQ score in T2DM patients with or without chronic HF, but did not significantly affect cardiac structural parameters indexed by body surface area. The LVEF level was improved only in HF patients with reduced ejection fraction.
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Yu et al. (2021) conducted a meta-analysis in Type 2 diabetes mellitus with or without chronic heart failure (n=10,978). Sodium-glucose cotransporter 2 inhibitors vs. Placebo or other antidiabetic drugs was evaluated on Plasma NT-proBNP level (SMD -0.09, 95% CI -0.16 to -0.03, p=0.004). SGLT2 inhibitors reduced plasma NT-proBNP levels and improved quality of life scores in T2DM patients with or without chronic heart failure, but did not affect cardiac structural parameters.
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