SGLT2 inhibitors and cardiac remodelling: a systematic review and meta‐analysis of randomized cardiac magnetic resonance imaging trials

Abstract

Aims Recent large randomized controlled trials (RCTs) have demonstrated efficacy of sodium‐glucose cotransporter‐2 inhibitors (SGLT2i) in both preventing and treating heart failure (HF). SGLT2i‐induced reversal of left ventricular remodelling has been proposed as a mechanism contributing to this effect. Methods and results We performed a systematic review and meta‐analysis of RCTs to compare SGLT2i versus placebo (treatment duration >3 months) on cardiac remodelling parameters as measured by cardiac magnetic resonance imaging (cMRI) in patients with HF and/or diabetes. The PubMed and ClinicalTrials.gov databases were searched until 15 June 2021. Our primary outcome was change in absolute left ventricular mass (LVM) from baseline to study endpoint. Secondary outcomes included changes in LVM indexed to body surface area, left ventricular end‐systolic volume (LVESV), left ventricular end‐diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) from baseline to study endpoint. The Cochrane Collaboration's tool was used to assess risk of bias. Five studies representing 408 patients were included. SGLT2i was associated with greater LVM regression compared to placebo (MD, −5.76 g; 95% CI, −10.87 g to −0.64 g, I2 = 73%; overall effect, P < 0.03; four RCTs). Statistical subgroup differences were not observed in our sensitivity analysis focusing on HF with reduced ejection fraction (P = 0.37) and were observed in our sensitivity analysis focusing on diabetes (P < 0.001). SGLT2i was not associated with statistical changes in LV mass indexed to body surface area (I2 = 75%; P = 0.16; five RCTs), LVESV (I2 = 87%; P = 0.07; five RCTs), LVEDV (I2 = 81%; P = 0.20; five RCTs), nor LVEF (I2 = 85%; P = 0.19; five RCTs) versus placebo. Sixty per cent of RCTs had low risk of bias. Conclusions Sodium‐glucose cotransporter‐2 inhibitors treatment was associated with a reduction in left ventricular mass as assessed by cMRI.

Dynamic Secondary Mitral Regurgitation: Current Evidence and Challenges for the Future

“…A meta-analysis of three cardiac magnetic resonance imaging trials reported that SGLT2i therapy in patients with HFrEF was not significantly associated with reverse cardiac remodeling, including left ventricular ejection fraction, end-systolic volume, and end-diastolic volume; however, there was a tendency toward the improvement of these parameters ( 42 ).…”

Reversibility of adverse cardiac remodeling in type 2 diabetes mellitus patients: focus on sodium-glucose cotransporter-2 inhibitors

“…The meta-analyses, which have been previously reported, have demonstrated controversial data regarding cardiac protection and the possibility to reverse adverse cardiac remodeling. Indeed, Yu et al (2021) [33] did not find strong evidence that SGLT2 inhibitors influence ACR parameters, such as LV mass index, LV enddiastolic and end-systolic volume indexes, or left atrial volume index; however, the beneficial changes in the E/e' ratio, biological markers (e.g., NT-pro brain natriuretic peptide) and quality of life have been concisely determined. In addition, SGLT2 inhibitors appeared to be significantly effective in LV ejection fraction increase solely among patients with HFrEF.…”

New principles for the treatment of chronic heart failure: the phenomenon of sodium-glucose cotransporter type 2 inhibitors

“…Гипертрофия, фиброз и воспаление миокарда приводят к ремоделированию сердца при ХСН, которое признается основным фактором, определяющим ее тяжесть [50]. ИНГК2 уменьшали ремоделирование миокарда у пациентов с СД 2-го типа и гипертрофией левого желудочка, но не у больных с ХСН [51]. Это повышает вероятность прямого кардиотропного эффекта ИНГК2 при ХСН за пределами снижения нагрузки на желудочки и влияния на ремоделирование миокарда.…”

“…Объединенный анализ данных об участниках исследований DAPA-HF и DAPA-CKD без СД (n = 4 003) показал, что лечение дапаглифлозином снижает заболеваемость впервые выявленным СД 2-го типа [63]. Эффект, подобный влиянию метформина, на профилактику СД 2-го типа отмечался без изменения уровня гемоглобина A1c, что 2022;16 (17): [44][45][46][47][48][49][50][51] Хроническая сердечная недостаточность свидетельствует не о маскировке гипергликемии гипогликемизирующим препаратом, а о существенном влиянии на патогенез СД, возможно, улучшении функции β-клеток или усилении чувствительности к инсулину.…”

“…MEDITSINSKIY SOVET 2022;16 (17): [44][45][46][47][48][49][50][51] Chronic heart failure ВВЕДЕНИЕ Распространенность, бремя заболеваемости и стоимости лечения хронической сердечной недостаточности (ХСН), прежде всего из-за затрат на госпитализации по поводу декомпенсированной сердечной недостаточности, продолжают оставаться важнейшими проблемами клинической кардиологии. Недавно сообщалось, что распространенность ХСН среди взрослого населения составляет не менее 2% [1], но реальным представляется показатель 7% в общей популяции, представленный российскими экспертами [2].…”