Effects of Sodium/Glucose Cotransporter 2 (SGLT2) Inhibitors on Cardiac Imaging Parameters: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Recent studies have shown that sodium/glucose cotransporter 2 (SGLT2) inhibitors might exert favourable changes on cardiac parameters as observed on cardiovascular imaging. We conducted a systematic review and meta-analysis to determine the effects of SGLT2 inhibitors on cardiac imaging parameters. Four electronic databases (PubMed, Embase, Cochrane, Scopus) were searched for studies in which the effects of SGLT2 inhibitors on cardiac imaging parameters were examined. Studies in which a population was administered SGLT2 inhibitors and analysed by echocardiography and/or cardiac magnetic resonance (CMR) imaging were included. Random-effects pair-wise meta-analysis models were utilized to summarize the studies. A total of 11 randomized controlled trials was included with a combined cohort of 910 patients. Comparing patients receiving SGLT2 inhibitors with subjects receiving placebo, the mean change in CMR-measured left ventricular mass (LVM) was -3.87 g (95% confidence interval [CI], -7.77 to 0.04), that in left ventricular end-systolic volume (LVESV) was -5.96 mL (95% CI, -10.52 to -1.41) for combined LVESV outcomes, that in left atrial volume index (LAVi) was -1.78 mL/m² (95% CI, -3.01 to -0.55) for combined LAVi outcomes, and that in echocardiography-measured E/e' was -0.73 (95% CI, -1.43 to -0.03). Between-group differences were not observed in LVM and LVESV after indexation. The only between-group difference that persisted was for LAVi. Treatment with SGLT2 inhibitors resulted in reduction in LAVi and E/e' on imaging, indicating they might have an effect on outcomes associated with LV diastolic function.

Keywords: Echocardiography; Heart failure; Magnetic resonance imaging; Pharmacology.

Figure 1. PRISMA flow diagram of study selection.

PRISMA: Preferred Reporting Items of Systematic Reviews and Meta-Analyses.

Figure 2. LAV parameters. (A) Forest plot of mean change in LAV in mL. (B) Forest plot of mean change in LAVi in mL/m².

CI: confidence interval, IV: interval variable, LAV: left atrial volume, LAVi: left atrial volume index, MRI: magnetic resonance imaging, SD: standard deviation, SGLT2i: sodium-glucose cotransporter 2 inhibitor.

Figure 3. LVM parameters. (A) Forest plot of mean change in LVM in g. (B) Forest plot of mean change in LVMi in g/m².

CI: confidence interval, IV: interval variable, LVM: left ventricular mass, LVMi: left ventricular mass index, MRI: magnetic resonance imaging, SD: standard deviation, SGLT2i: sodium-glucose cotransporter 2 inhibitor.

Figure 4. LV volume parameters. (A) Forest plot of mean change in LVESV in mL. (B) Forest plot of mean change in LVESVi in mL/m². (C) Forest plot of mean change in LVEDV in mL. (D) Forest plot of mean change in LVEDVi in mL/m².

CI: confidence interval, IV: interval variable, LV: left ventricular, LVEDV: left ventricular end-diastolic volume, LVEDVi: left ventricular end-diastolic volume index, LVESV: left ventricular end-systolic volume, LVESVi: left ventricular end-systolic volume index, MRI: magnetic resonance imaging, SD: standard deviation, SGLT2i: sodium-glucose cotransporter 2 inhibitor.

Figure 5. LV function parameters. (A) Forest plot of mean change in LVEF in %. (B) Forest plot of mean change in LVGLS in %. (C) Forest plot of mean change in stroke volume in mL.

CI: confidence interval, IV: interval variable, LV: left ventricular, LVEF: left ventricular ejection fraction, LVGLS: left ventricular global longitudinal strain, MRI: magnetic resonance imaging, SD: standard deviation, SGLT2i: sodium-glucose cotransporter 2 inhibitor.

Figure 6. Forest plot of mean change in E/e′.

CI: confidence interval, IV: interval variable, MRI: magnetic resonance imaging, SD: standard deviation, SGLT2i: sodium-glucose cotransporter 2 inhibitor.