Fukuta Hidekatsu, Hagiwara Hiromi, Kamiya Takeshi
Core Laboratory, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Department of Medical Innovation, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
Int J Cardiol Heart Vasc. 2022 Aug 11;42:101103. doi: 10.1016/j.ijcha.2022.101103. eCollection 2022 Oct.
Nearly half of patients with heart failure (HF) have preserved ejection fraction (EF) and the mortality and morbidity of patients with HF with preserved EF (HFpEF) are high. Patients with HFpEF are often elderly and their primary chronic symptom is severe exercise intolerance that results in a reduced quality of life. Thus, improvement of exercise capacity and quality of life presents another important clinical outcome in HFpEF patients. Recent randomized controlled trials (RCTs) and meta-analyses of RCTs reported that sodium-glucose cotransporter 2 (SGLT-2) inhibitors improved cardiovascular (CV) outcomes in patients with HF with reduced EF. Although the effects of SGLT-2 inhibitors in HFpEF patients have been examined in multiple RCTs, results are inconsistent due partly to limited power. We aimed to conduct a meta-analysis of RCTs on the effects of SGLT-2 inhibitors in HFpEF patients.
The search of electronic databases identified 11 RCTs including 10,845 patients. In pooled analyses, SGLT-2 inhibitors reduced the risk of a composite of hospitalization for HF and CV death (hazard ratio [95 % CI] = 0.78 [0.70, 0.87], P < 0.001). SGLT-2 inhibitors significantly increased 6-minute walk distance (weighted mean difference [95 % CI] = 18.0 [6.8, 29.3] m; P = 0.002) and the Kansas City Cardiomyopathy Questionnaire Total Symptom Score (weighted mean difference [95 % CI] = 2.57 [0.19, 4.96] points; P = 0.035) and reduced plasma NT-pro B-type natriuretic peptide levels (weighted mean difference [95 % CI] = -60.16 [-82.99, -37.33] pg/ml; P < 0.001) compared with control.
The present meta-analysis suggests that SGLT-2 inhibitors may be beneficial for HFpEF patients, especially in diabetic patients.
近一半的心力衰竭（HF）患者射血分数（EF）保留，射血分数保留的心力衰竭（HFpEF）患者的死亡率和发病率较高。HFpEF患者通常为老年人，其主要慢性症状是严重的运动不耐受，这导致生活质量下降。因此，提高运动能力和生活质量是HFpEF患者的另一个重要临床结局。最近的随机对照试验（RCT）和RCT的荟萃分析报告称，钠-葡萄糖协同转运蛋白2（SGLT-2）抑制剂可改善射血分数降低的心力衰竭患者的心血管（CV）结局。尽管在多个RCT中已研究了SGLT-2抑制剂对HFpEF患者的影响，但部分由于样本量有限，结果并不一致。我们旨在对关于SGLT-2抑制剂对HFpEF患者影响的RCT进行荟萃分析。
对电子数据库的检索确定了11项RCT，包括10845例患者。在汇总分析中，SGLT-2抑制剂降低了因HF住院和CV死亡的复合风险（风险比[95%CI]=0.78[0.70，0.87]，P<0.001）。与对照组相比，SGLT-2抑制剂显著增加了6分钟步行距离（加权平均差[95%CI]=18.0[6.8，29.3]m；P=0.002）和堪萨斯城心肌病问卷总症状评分（加权平均差[95%CI]=2.57[0.19，4.96]分；P=0.035），并降低了血浆N末端B型利钠肽原水平（加权平均差[95%CI]=-60.16[-82.99，-37.33]pg/ml；P<0.001）。
本荟萃分析表明，SGLT-2抑制剂可能对HFpEF患者有益，尤其是糖尿病患者。
