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Review
. 2022 Apr 14;12(4):989.
doi: 10.3390/diagnostics12040989.

Sodium-Glucose Cotransporter-2 Inhibitors Improve Heart Failure with Reduced Ejection Fraction Outcomes by Reducing Edema and Congestion

Michelle Hernandez  1   2 , Ryan D Sullivan  1 , Mariana E McCune  1 , Guy L Reed  1 , Inna P Gladysheva  1
Affiliations
Review

Sodium-Glucose Cotransporter-2 Inhibitors Improve Heart Failure with Reduced Ejection Fraction Outcomes by Reducing Edema and Congestion

Michelle Hernandez et al. Diagnostics (Basel). .

Abstract

Pathological sodium-water retention or edema/congestion is a primary cause of heart failure (HF) decompensation, clinical symptoms, hospitalization, reduced quality of life, and premature mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT-2i) based therapies reduce hospitalization due to HF, improve functional status, quality, and duration of life in patients with HF with reduced ejection fraction (HFrEF) independently of their glycemic status. The pathophysiologic mechanisms and molecular pathways responsible for the benefits of SGLT-2i in HFrEF remain inconclusive, but SGLT-2i may help HFrEF by normalizing salt-water homeostasis to prevent clinical edema/congestion. In HFrEF, edema and congestion are related to compromised cardiac function. Edema and congestion are further aggravated by renal and pulmonary abnormalities. Treatment of HFrEF patients with SGLT-2i enhances natriuresis/diuresis, improves cardiac function, and reduces natriuretic peptide plasma levels. In this review, we summarize current clinical research studies related to outcomes of SGLT-2i treatment in HFrEF with a specific focus on their contribution to relieving or preventing edema and congestion, slowing HF progression, and decreasing the rate of rehospitalization and cardiovascular mortality.

Keywords: HFrEF; congestion; dilated cardiomyopathy; edema; endothelial dysfunction; fluid management.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Summary of Mechanisms Contributing to Outcomes of SGLT-2i on Edema/Congestion in HFrEF [15,16,17,37,38,39,40,41,42,43,44,45,46,47,48,68,69].
Figure 2
Figure 2
Schematic presentation of SGLT-2i Contribution to Attenuation of Edema/Congestion in HFrEF. Created with BioRender.com.
See this image and copyright information in PMC

References

    1. McDonagh T.A., Metra M., Adamo M., Gardner R.S., Baumbach A., Bohm M., Burri H., Butler J., Celutkiene J., Chioncel O., et al. 2021 Esc Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure. Eur. Heart J. 2021;42:3599–3726. doi: 10.1093/eurheartj/ehab368. - DOI - PubMed
    1. Bozkurt B., Coats A.J., Tsutsui H., Abdelhamid M., Adamopoulos S., Albert N., Anker S.D., Atherton J., Bohm M., Butler J., et al. Universal Definition and Classification of Heart Failure: A Report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. J. Card. Fail. 2021;27:387–413. doi: 10.1016/j.cardfail.2021.01.022. - DOI - PubMed
    1. Bozkurt B., Coats A.J.S., Tsutsui H., Abdelhamid C.M., Adamopoulos S., Albert N., Anker S.D., Atherton J., Bohm M., Butler J., et al. Universal Definition and Classification of Heart Failure: A Report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure: Endorsed by the Canadian Heart Failure Society, Heart Failure Association of India, Cardiac Society of Australia and New Zealand, and Chinese Heart Failure Association. Eur. J. Heart Fail. 2021;23:352–380. doi: 10.1002/ejhf.2115. - DOI - PubMed
    1. Weber K.T. Aldosterone in Congestive Heart Failure. N. Engl. J. Med. 2001;345:1689–1697. doi: 10.1056/NEJMra000050. - DOI - PubMed
    1. Ware L.B., Matthay M.A. Clinical Practice. Acute Pulmonary Edema. N. Engl. J. Med. 2005;353:2788–2796. doi: 10.1056/NEJMcp052699. - DOI - PubMed