Suppression of Cardiogenic Edema with Sodium–Glucose Cotransporter-2 Inhibitors in Heart Failure with Reduced Ejection Fraction: Mechanisms and Insights from Pre-Clinical Studies

Sullivan, Ryan D.; McCune, Mariana E.; Hernandez, M Vanegas; Reed, Guy L.; Gladysheva, Inna P.

doi:10.3390/biomedicines10082016

Cited by 5 publications

(4 citation statements)

References 127 publications

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“…The diuretic/natriuretic properties of SGLT2 inhibitors may offer benefits in reducing congestion and may allow a reduction in loop diuretic requirement [2,80]. HFrEF pre-clinical studies have shown that SGLT2 inhibitors treatment may attenuate edema formation not only through the stimulation of natriuretic and osmotic/diuretic effects, but also through improvement in overall cardiac function, and the suppression of maladaptive cardiac remodeling, chronic inflammation, oxidative stress, and endothelial dysfunction [81]. Clinical HFrEF studies also suggest that SGLT-2 inhibitors treatment may attenuate the pathological salt-water retention [82].…”

Section: Sodium-glucose Co-transporter 2 Inhibitors (Sglt2 Inhibitors)mentioning

confidence: 99%

The Importance of Optimal Hydration in Patients with Heart Failure—Not Always Too Much Fluid

Wittczak,

Ślot,

Bielecka-Dabrowa

2023

Biomedicines

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Heart failure (HF) is a leading cause of morbidity and mortality and a major public health problem. Both overhydration and dehydration are non-physiological states of the body that can adversely affect human health. Congestion and residual congestion are common in patients hospitalized for HF and are associated with poor prognosis and high rates of rehospitalization. However, the clinical problem of dehydration is also prevalent in healthcare and community settings and is associated with increased morbidity and mortality. This article provides a comprehensive review of the issue of congestion and dehydration in HF, including HF guidelines, possible causes of dehydration in HF, confirmed and potential new diagnostic methods. In particular, a full database search on the relationship between dehydration and HF was performed and all available evidence in the literature was reviewed. The novel hypothesis of chronic subclinical hypohydration as a modifiable risk factor for HF is also discussed. It is concluded that maintaining euvolemia is the cornerstone of HF management. Physicians have to find a balance between decongestion therapy and the risk of dehydration.

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Section: Sodium-glucose Co-transporter 2 Inhibitors (Sglt2 Inhibitors)mentioning

confidence: 99%

The Importance of Optimal Hydration in Patients with Heart Failure—Not Always Too Much Fluid

Wittczak,

Ślot,

Bielecka-Dabrowa

2023

Biomedicines

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“…The decongestive power of SGLT2i has been studied in acute settings [ 10 , 11 ]. SGLT2i, in fact, may indirectly slow edema development with different mechanisms, such as improvement of the stroke volume and reduction of inflammation and endothelial dysfunction, as is further discussed [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Sizing SGLT2 Inhibitors Up: From a Molecular to a Morpho-Functional Point of View

Prosperi,

D’Amato,

Severino

et al. 2023

IJMS

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Sodium–glucose cotransporter 2 inhibitors (SGLT2i), or gliflozins, have recently been shown to reduce cardiovascular death and hospitalization in patients with heart failure, representing a revolutionary therapeutic tool. The purpose of this review is to explore their multifaceted mechanisms of actions, beyond their known glucose reduction power. The cardioprotective effects of gliflozins seem to be linked to the maintenance of cellular homeostasis and to an action on the main metabolic pathways. They improve the oxygen supply for cardiomyocytes with a considerable impact on both functional and morphological myocardial aspects. Moreover, multiple molecular actions of SGLT2i are being discovered, such as the reduction of both inflammation, oxidative stress and cellular apoptosis, all responsible for myocardial damage. Various studies showed controversial results concerning the role of SGLT2i in reverse cardiac remodeling and the lowering of natriuretic peptides, suggesting that their overall effect has yet to be fully understood. In addition to this, advanced imaging studies evaluating the effect on all four cardiac chambers are lacking. Further studies will be needed to better understand the real impact of their administration, their use in daily practice and how they can contribute to benefits in terms of reverse cardiac remodeling.

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“…Implementation of modern treatments, for instance sacubitril/valsartan and sodium-glucose co-transporter-2 inhibitors ( 5 , 6 ), in clinical practice is required to improve management of congestion and, importantly, long term outcomes in patients with HFrEF. However, further research is needed to develop affordable methods and strategies that combine biomarkers, imaging modalities and other diagnostic tools to detect, quantify and monitor edema due to cardiac dysfunction timely and with precision ( Figure 1 ).…”

mentioning

confidence: 99%

Editorial: Edema in heart failure with reduced ejection fraction

Gladysheva

Sullivan

Pellicori

2023

Front. Cardiovasc. Med.

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Suppression of Cardiogenic Edema with Sodium–Glucose Cotransporter-2 Inhibitors in Heart Failure with Reduced Ejection Fraction: Mechanisms and Insights from Pre-Clinical Studies

Cited by 5 publications

References 127 publications

The Importance of Optimal Hydration in Patients with Heart Failure—Not Always Too Much Fluid

The Importance of Optimal Hydration in Patients with Heart Failure—Not Always Too Much Fluid

Sizing SGLT2 Inhibitors Up: From a Molecular to a Morpho-Functional Point of View

Editorial: Edema in heart failure with reduced ejection fraction

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