Why the study?
Imaging-derived and hemodynamic changes accompanying SGLT2 inhibitor benefits in heart failure remain incompletely characterized, and whether cardiac remodeling patterns differ between HFrEF and HFpEF is unknown.
Do SGLT2 inhibitors improve cardiac remodeling parameters (imaging and hemodynamics) in adults with chronic heart failure compared to non-SGLT2-inhibitor comparators?
Population
1232 participants across 13 unique RCTs in adults with chronic HF
Comparison
SGLT2 inhibitors vs non-SGLT2-inhibitor comparator
Design
Systematic review of randomized controlled trials
Follow-up
At least three months
Key result
SGLT2 inhibitors reduced resting pulmonary capillary wedge pressure by 3.5 mmHg (95% CI -6.6 to -0.4) in HFpEF, while effects on left ventricular volumes in HFrEF were inconsistent.
Authors
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Suggests phenotype-specific hemodynamic relief in HFpEF; extends mechanistic data but very low-certainty evidence leaves practice implications open.
Systematic Review (n=1,232)
Do SGLT2 inhibitors improve cardiac remodeling parameters (imaging and hemodynamics) in adults with chronic heart failure compared to non-SGLT2-inhibitor comparators?
SGLT2 inhibitors appear to induce phenotype-specific cardiac remodeling in heart failure, with structural reverse remodeling seen primarily in reduced ejection fraction and hemodynamic improvements in preserved ejection fraction.
Buzzi et al. (2026) conducted a systematic review in chronic heart failure (n=1,232). SGLT2 inhibitors vs. non-SGLT2-inhibitor comparator was evaluated on cardiac structure, function or loading parameters. SGLT2 inhibitors reduced resting pulmonary capillary wedge pressure by 3.5 mmHg (95% CI -6.6 to -0.4) in HFpEF, while effects on left ventricular volumes in HFrEF were inconsistent.