Sodium-glucose cotransporter 2 inhibitors reduced left ventricular mass index by 6.57 g/m², while beta-blockers improved left ventricular ejection fraction by 3.54%.
Do 'New Tetralogy' drugs (ARNI, SGLT2i, BB, MRA) improve ventricular remodeling parameters compared to placebo or each other in patients with HFrEF?
This network meta-analysis demonstrates that each class of the 'New Tetralogy' drugs provides distinct structural and functional benefits for ventricular remodeling in HFrEF, supporting personalized therapeutic strategies.
Absolute Event Rate: 0% vs 0%
BACKGROUND: Heart failure, particularly heart failure with reduced ejection fraction (HFrEF), represents a major global health challenge due to its high prevalence, rapid progression, and substantial mortality rates. While the “New Tetralogy” drugs (angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, beta-blockers, and mineralocorticoid receptor antagonists) have significantly advanced HFrEF management, their comparative effects on ventricular remodeling remain unclear. This network meta-analysis systematically evaluates these therapeutic agents to inform optimal clinical decision-making. METHODS: We conducted a comprehensive search of PubMed, Cochrane Library, Embase, and Web of Science for randomized controlled trials (RCTs) evaluating ventricular remodeling parameters in HFrEF patients. Twenty-two RCTs involving 16,425 participants were included. Data were analyzed using Stata 14.2 and RevMan 5.3, with outcomes expressed as mean differences (MD) and 95% confidence intervals (CI). RESULTS: Our study showed markedly different therapeutic characteristics: sodium-glucose cotransporter 2 inhibitors significantly reduced left ventricular mass index (MD = -6.57, 95% CI: -11.98 to -1.16), while beta-blockers demonstrated superior improvement in left ventricular ejection fraction compared to mineralocorticoid receptor antagonists (MD = 3.54, 95% CI: 0.60 to 6.48) through indirect comparison. Mineralocorticoid receptor antagonists showed greater efficacy in reducing left ventricular end-systolic volume (MD = -22.10, 95% CI: -31.42 to -12.78). Angiotensin receptor-neprilysin inhibitors outperformed renin-angiotensin system inhibitors across multiple parameters, including left ventricular end-systolic volume (MD = -7.00, 95% CI: -13.91 to -0.09), end-systolic volume index (MD = -13.78, 95% CI: -25.98 to -1.58), and end-diastolic volume index (MD = -5.80, 95% CI: -9.76 to -1.84). CONCLUSIONS: This network meta-analysis demonstrates that each component of the “New Tetralogy” applies unique beneficial effects on ventricular remodeling. Angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors, and mineralocorticoid receptor antagonists predominantly improve ventricular volumes, while beta-blockers significantly enhance systolic function. These findings provide evidence-based guidance for personalized therapeutic strategies in HFrEF management, particularly for patients with persistent left ventricular systolic dysfunction. CLINICAL TRIAL NUMBER: Not applicable. REGISTRATION NUMBER: CRD42023454737. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-025-05173-x.
Wang et al. (Tue,) reported a other. Sodium-glucose cotransporter 2 inhibitors reduced left ventricular mass index by 6.57 g/m², while beta-blockers improved left ventricular ejection fraction by 3.54%.