Impact of sodium-glucose co-transporter inhibitors in mortality and decongestion in cardiac amyloidosis: A systematic review and meta-analysis

Abstract Background Sodium-glucose co-transporter inhibitors (SGLT2i) have been associated with improved outcomes in heart failure patients, reducing hospitalizations and mortality. However, patients with cardiac amyloidosis were largely excluded from major trials. Therefore, we conducted a meta-analysis to evaluate the potential benefits of SGLT2i in this population. Purpose To assess the potential benefits of SGLT2i in patients with cardiac amyloidosis. Methods We searched PubMed and Embase for studies comparing SGLT2i use with placebo in patients with cardiac amyloidosis. The primary outcomes analyzed were: (1) all-cause mortality, (2) cardiovascular mortality, (3) hospitalizations, and (4) NT-proBNP levels. A random-effects model was used to calculate the pooled risk ratio (RR) or mean difference (MD) with a 95% confidence interval (CI). Heterogeneity was assessed using Cochran’s Q test and I² statistics. Results We included five observational studies comprising 5,101 patients, of whom 2,528 were receiving SGLT2i. The mean follow-up period ranged from 3 months to 8.7 years. All-cause mortality was significantly lower in the SGLT2i group compared to controls (Figure 1a: RR 0.37; 95% CI 0.28–0.49; p 0.00001; I² = 12%). Cardiovascular mortality was also significantly reduced in the SGLT2i group (Figure 1b: RR 0.30; 95% CI 0.16–0.55; p 0.00001; I² = 25%). NT-proBNP levels were significantly lower in the SGLT2i group (Figure 2a: MD -299.66; 95% CI -493.24 to -106.08; p = 0.002; I² = 0%). There was no significant difference in hospitalization rates between groups (Figure 2b: RR 0.75; 95% CI 0.17–3.38; p = 0.70; I² = 94%). Conclusion These findings suggest that SGLT2i use in cardiac amyloidosis is associated with significant reductions in all-cause mortality, cardiovascular mortality, and NT-proBNP levels. However, no significant impact on hospitalization rates was observed. Further randomized controlled trials are warranted to confirm these results