SGLT2 抑制剂与心脏重构：随机心脏磁共振成像试验的系统评价和荟萃分析。
SGLT2 inhibitors and cardiac remodelling: a systematic review and meta-analysis of randomized cardiac magnetic resonance imaging trials.
机构信息
Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada.
Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
出版信息
ESC Heart Fail. 2021 Dec;8(6):4693-4700. doi: 10.1002/ehf2.13645. Epub 2021 Oct 8.
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, I = 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 (I = 75%; P = 0.16; five RCTs), LVESV (I = 87%; P = 0.07; five RCTs), LVEDV (I = 81%; P = 0.20; five RCTs), nor LVEF (I = 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.
目的
最近的几项大型随机对照试验（RCT）已经证明钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）在预防和治疗心力衰竭（HF）方面均具有疗效。SGLT2i 诱导的左心室重构逆转被认为是其产生这种作用的机制之一。
方法和结果
我们对 RCT 进行了系统评价和荟萃分析，比较了 SGLT2i 与安慰剂（治疗时间 >3 个月）在 HF 和/或糖尿病患者中通过心脏磁共振成像（cMRI）测量的心脏重构参数上的差异。我们检索了 PubMed 和 ClinicalTrials.gov 数据库，检索时间截至 2021 年 6 月 15 日。我们的主要结局是从基线到研究终点时绝对左心室质量（LVM）的变化。次要结局包括从基线到研究终点时 LVM 与体表面积的比值、左心室收缩末期容积（LVESV）、左心室舒张末期容积（LVEDV）和左心室射血分数（LVEF）的变化。我们使用 Cochrane 协作网的工具评估了偏倚风险。纳入了 5 项研究，共 408 例患者。与安慰剂相比，SGLT2i 治疗与更大的 LVM 逆转相关（MD，-5.76 g；95%CI，-10.87 g 至-0.64 g，I ² = 73%；总效应，P < 0.03；4 项 RCT）。我们的敏感性分析重点关注射血分数降低的 HF 时，并未观察到统计学亚组差异（P = 0.37），而当我们的敏感性分析重点关注糖尿病时，则观察到了统计学差异（P < 0.001）。SGLT2i 与 LVM 与体表面积的比值（I ² = 75%；P = 0.16；5 项 RCT）、LVESV（I ² = 87%；P = 0.07；5 项 RCT）、LVEDV（I ² = 81%；P = 0.20；5 项 RCT）和 LVEF（I ² = 85%；P = 0.19；5 项 RCT）的变化相比，均无统计学差异。60%的 RCT 具有低偏倚风险。
结论
cMRI 评估显示，SGLT2i 治疗与左心室质量的减少有关。
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