SGLT2 inhibitors significantly reduced left ventricular end-diastolic volume by 10.59 ml and end-systolic volume by 8.80 ml compared to controls in patients with heart failure.
Meta-Analysis (n=1,385)
Does SGLT2i therapy improve left ventricular remodeling (LVEDV, LVESV, LVEF, LVMi) in patients with heart failure?
SGLT2 inhibitors significantly reverse adverse cardiac remodeling by reducing left ventricular volumes and mass while improving ejection fraction, particularly in patients with HFrEF.
Effect estimate: MD -10.59 ml (95% CI -17.27 to -3.91)
p-value: p=0.0019
BACKGROUND: Randomized controlled trials (RCTs) reported contrasting results about reverse left ventricular remodeling (LVR) after sodium-glucose co-transporter-2 inhibitors (SGLT2i) therapy in patients with heart failure (HF). METHODS AND RESULTS: We performed a metanalysis of RCTs of SGLT2i administration in HF outpatients published until June 2022 searching four electronic databases. The protocol has been published in PROSPERO. Primary LVR outcome was change in absolute LV end-diastolic (LVEDV) and end-systolic volume (LVESV) from baseline to study endpoint. Secondary outcomes included changes in LVEDV and LVESV indexed to body surface area, LV Mass index (LVMi), LV ejection fraction (LVEF), and N-terminal pro-B-type natriuretic peptide (NTproBNP). Mean differences (MDs) with 95% CIs were pooled. A total of 9 RCTs (1385 patients) were analyzed. All of them reported data on LVEF. Six trials reported data on LVESV and LVEDV (n = 951); LVMi was available in 640. SGLT2i treatment significantly reduced LVEDV MD= -10.59 ml (-17.27; -3.91), P = 0.0019, LVESV MD= -8.80 ml (-16.91; -0.694), P = 0.0334, and LVMI MD= -5.34 gr/m2 (-9.76; -0.922), P = 0.0178, while LVEF significantly increased MD = + 1.98% (0.67; 0.306), P = 0.0031. By subgroup analysis, the beneficial effects of SGLT2i on LVEF did not differ by imaging method used, time to follow-up re-evaluation, or HF phenotype. Reduction in LV volumes tended to be greater in HF with reduced EF (HFrEF) than in those with preserved EF (HFpEF), while the opposite was observed for LVMi. CONCLUSIONS: Treatment with SGLT2i significantly reversed cardiac volumes, improving LV systolic function and LV mass, particularly in HFrEF patients.
Carluccio et al. (Sat,) conducted a meta-analysis in Heart failure (n=1,385). SGLT2 inhibitors vs. Placebo or active control was evaluated on Change in absolute LV end-diastolic volume (LVEDV) from baseline to study endpoint (MD -10.59 ml, 95% CI -17.27 to -3.91, p=0.0019). SGLT2 inhibitors significantly reduced left ventricular end-diastolic volume by 10.59 ml and end-systolic volume by 8.80 ml compared to controls in patients with heart failure.