Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2023 Sep 2;22(1):235.
doi: 10.1186/s12933-023-01970-w.

Left ventricular remodeling response to SGLT2 inhibitors in heart failure: an updated meta-analysis of randomized controlled studies

Erberto Carluccio  1 , Paolo Biagioli  2 , Gianpaolo Reboldi  3 , Anna Mengoni  2 , Rosanna Lauciello  2 , Cinzia Zuchi  2 , Sandra D'Addario  2 , Giuliana Bardelli  2 , Giuseppe Ambrosio  2   4
Affiliations
Meta-Analysis

Left ventricular remodeling response to SGLT2 inhibitors in heart failure: an updated meta-analysis of randomized controlled studies

Erberto Carluccio et al. Cardiovasc Diabetol. .

Abstract

Background: Randomized controlled trials (RCTs) reported contrasting results about reverse left ventricular remodeling (LVR) after sodium-glucose co-transporter-2 inhibitors (SGLT2i) therapy in patients with heart failure (HF).

Methods and results: We performed a metanalysis of RCTs of SGLT2i administration in HF outpatients published until June 2022 searching four electronic databases. The protocol has been published in PROSPERO. Primary LVR outcome was change in absolute LV end-diastolic (LVEDV) and end-systolic volume (LVESV) from baseline to study endpoint. Secondary outcomes included changes in LVEDV and LVESV indexed to body surface area, LV Mass index (LVMi), LV ejection fraction (LVEF), and N-terminal pro-B-type natriuretic peptide (NTproBNP). Mean differences (MDs) with 95% CIs were pooled. A total of 9 RCTs (1385 patients) were analyzed. All of them reported data on LVEF. Six trials reported data on LVESV and LVEDV (n = 951); LVMi was available in 640. SGLT2i treatment significantly reduced LVEDV [MD= -10.59 ml (-17.27; -3.91), P = 0.0019], LVESV [MD= -8.80 ml (-16.91; -0.694), P = 0.0334], and LVMI [MD= -5.34 gr/m2 (-9.76; -0.922), P = 0.0178], while LVEF significantly increased [MD = + 1.98% (0.67; 0.306), P = 0.0031]. By subgroup analysis, the beneficial effects of SGLT2i on LVEF did not differ by imaging method used, time to follow-up re-evaluation, or HF phenotype. Reduction in LV volumes tended to be greater in HF with reduced EF (HFrEF) than in those with preserved EF (HFpEF), while the opposite was observed for LVMi.

Conclusions: Treatment with SGLT2i significantly reversed cardiac volumes, improving LV systolic function and LV mass, particularly in HFrEF patients.

Keywords: Cardiac magnetic resonance imaging; Echocardiography, Cardiac remodelling; HFrEF, HFpEF; SGLT2i.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram showing detailed study selection process
Fig. 2
Fig. 2
Forest plots showing the effects of SGLT2 inhibitors on (A) LV end-diastolic volume; (B) LV end-systolic volume; (C) LV Ejection Fraction; (D) LV Mass Index; and (E) NT-proBNP.
Fig. 3
Fig. 3
Forrest plot showing changes in end-diastolic volume index (A) and end-systolic volume index (B) from baseline to study endpoint in randomized controlled trials of heart failure patients treated with sodium glucose transporter-2 inhibitor therapy versus controls
Fig. 4
Fig. 4
Forrest plot showing changes in LV Ejection Fraction from baseline to study endpoint in randomized controlled trials of heart failure patients treated with sodium glucose transporter-2 inhibitor therapy versus controls, according to pre-specified subgroups
See this image and copyright information in PMC

References

    1. McMurray JJV, Solomon SD, Inzucchi SE, Kober L, Kosiborod MN, Martinez FA, Ponikowski P, Sabatine MS, Anand IS, Belohlavek J, et al. Dapagliflozin in patients with heart failure and reduced ejection fraction. N Engl J Med. 2019;381:1995–2008. doi: 10.1056/NEJMoa1911303. - DOI - PubMed
    1. Packer M, Anker SD, Butler J, Filippatos G, Pocock SJ, Carson P, Januzzi J, Verma S, Tsutsui H, Brueckmann M, et al. Cardiovascular and renal outcomes with Empagliflozin in Heart failure. N Engl J Med. 2020;383:1413–24. doi: 10.1056/NEJMoa2022190. - DOI - PubMed
    1. Anker SD, Butler J, Filippatos G, Ferreira JP, Bocchi E, Bohm M, Brunner-La Rocca HP, Choi DJ, Chopra V, Chuquiure-Valenzuela E, et al. Empagliflozin in Heart failure with a preserved ejection fraction. N Engl J Med. 2021;385:1451–61. doi: 10.1056/NEJMoa2107038. - DOI - PubMed
    1. Solomon SD, McMurray JJV, Claggett B, de Boer RA, DeMets D, Hernandez AF, Inzucchi SE, Kosiborod MN, Lam CSP, Martinez F, et al. Dapagliflozin in Heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387:1089–98. doi: 10.1056/NEJMoa2206286. - DOI - PubMed
    1. Lopaschuk GD, Verma S. Mechanisms of Cardiovascular benefits of Sodium glucose co-transporter 2 (SGLT2) inhibitors: a state-of-the-art review. JACC Basic Transl Sci. 2020;5:632–44. doi: 10.1016/j.jacbts.2020.02.004. - DOI - PMC - PubMed

Publication types

MeSH terms

Substances