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February 6, 2026European Heart Journal

Impact of SGLT2-inhibitors on cardiac function and structural changes in patients with heart failure and reduced ejection fraction - Results from the REWIN-HFrEF Study

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Why the study?

While SGLT2 inhibitors improve survival and reduce adverse events in HFrEF, less is known about their role in promoting cardiac structure and function changes.

Does SGLT2 inhibitor therapy improve echocardiographic parameters of cardiac structure and function in patients with stable chronic HFrEF?

Population

151 consecutive patients with stable chronic HFrEF

Comparison

Cardiac parameters before vs after 6 months of SGLT2i treatment

Design

Prospective multicenter observational cohort study

Follow-up

6 months

Key result

Six months of SGLT2 inhibitor therapy in ambulatory patients with HFrEF significantly increased mean ejection fraction from 32% to 35% (P<0.001) and improved left ventricular volumes.

Authors

MAM G De AngelisRIR M InciardiMCM Correale

Discussion

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Overview

Associated with LVEF improvement and reverse remodeling in HFrEF; extends outcome data but leaves open causality and practice change.

Key Points

  • To evaluate the effects of SGLT2 inhibitors on cardiac function and structure in patients with heart failure and reduced ejection fraction.
  • Conducted a prospective multicenter observational cohort study.
  • Enrolled 151 patients with stable chronic heart failure and reduced ejection fraction.
  • Collected baseline and follow-up data at six months.
  • Performed standard and advanced transthoracic echocardiography at enrollment and follow-up.
  • Mean ejection fraction increased from 32% to 35%, a significant improvement (P < 0.001).
  • Trends towards improvement in global longitudinal strain and right ventricular functional parameters observed.
  • Significant reductions in left ventricular end-diastolic and end-systolic volumes.
  • Left and right atrial volumes showed significant decreases.

Study Design

Type

Cohort (n=151)

Multicenter

Yes

Structured PICO

Does SGLT2 inhibitor therapy improve echocardiographic parameters of cardiac structure and function in patients with stable chronic HFrEF?

P
Population
151 ambulatory patients with stable chronic HFrEF (mean age 70 years, 19% female) evaluated at baseline and after 6 months of SGLT2 inhibitor therapy.
E
Exposure
SGLT2 inhibitors for 6 months
O
Outcome
Cardiac function and structural changes using conventional and advanced echocardiographic parameters (including speckle-tracking analysis) at 6 monthssurrogate

Main Result

Absolute Event Rate: 35% vs 32%

p-value: p=< 0.001

SGLT2 inhibitors significantly improve left ventricular ejection fraction and promote favorable reverse remodeling of ventricular and atrial volumes over 6 months in real-world patients with HFrEF.

Cite This Study

Angelis et al. (2025) conducted a cohort in heart failure with reduced ejection fraction (HFrEF) (n=151). SGLT2 inhibitors vs. Baseline was evaluated on mean ejection fraction (p=< 0.001). Six months of SGLT2 inhibitor therapy in ambulatory patients with HFrEF significantly increased mean ejection fraction from 32% to 35% (P<0.001) and improved left ventricular volumes.

synapsesocial.com/papers/698585bd8f7c464f2300960chttps://doi.org/10.1093/eurheartj/ehaf784.982
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