Pistelli Lorenzo, Parisi Francesca, Correale Michele, Cocuzza Federica, Campanella Francesca, de Ferrari Tommaso, Crea Pasquale, De Sarro Rosalba, La Cognata Olga, Ceratti Simona, Recupero Tonino, Ruocco Gaetano, Palazzuoli Alberto, Imbalzano Egidio, Dattilo Giuseppe
Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Section of Cardiology, University of Messina, 98122 Messina, Italy.
Cardiothoracic Department, University Hospital Policlinico Riuniti, 71100 Foggia, Italy.
J Clin Med. 2023 Jan 3;12(1):379. doi: 10.3390/jcm12010379.
Heart failure (HF) is a complex, multifactorial, progressive clinical condition affecting 64.3 million people worldwide, with a strong impact in terms of morbidity, mortality and public health costs. In the last 50 years, along with a better understanding of HF physiopathology and in agreement with the four main models of HF, many therapeutic options have been developed. Recently, the European Society of Cardiology (ESC) HF guidelines enthusiastically introduced inhibitors of the sodium-glucose cotransporter (SGLT2i) as first line therapy for HF with reduced ejection fraction (HFrEF) in order to reduce hospitalizations and mortality. Despite drugs developed as hypoglycemic agents, data from the EMPA-REG OUTCOME trial encouraged the evaluation of the possible cardiovascular effects, showing SGLT2i beneficial effects on loading conditions, neurohormonal axes, heart cells' biochemistry and vascular stiffness, determining an improvement of each HF model. We want to give a boost to their use by increasing the knowledge of SGLT2-I and understanding the probable mechanisms of this new class of drugs, highlighting strengths and weaknesses, and providing a brief comment on major trials that made Gliflozins a cornerstone in HF therapy. Finally, aspects that may hinder SGLT2-i widespread utilization among different types of specialists, despite the guidelines' indications, will be discussed.
心力衰竭（HF）是一种复杂的、多因素的、进行性的临床病症，全球有6430万人受其影响，在发病率、死亡率和公共卫生成本方面产生了重大影响。在过去50年里，随着对HF病理生理学的深入了解，并与HF的四种主要模型相一致，人们开发了许多治疗方案。最近，欧洲心脏病学会（ESC）的HF指南积极引入钠-葡萄糖协同转运蛋白抑制剂（SGLT2i），作为射血分数降低的心力衰竭（HFrEF）的一线治疗药物，以减少住院率和死亡率。尽管这些药物最初是作为降糖药开发的，但EMPA-REG OUTCOME试验的数据促使人们对其可能的心血管效应进行评估，结果显示SGLT2i对负荷状况、神经激素轴、心脏细胞生物化学和血管僵硬度具有有益作用，改善了每种HF模型。我们希望通过增加对SGLT2-I的了解，理解这类新药的可能机制，突出其优缺点，并对使格列净类药物成为HF治疗基石的主要试验进行简要评论，来推动它们的使用。最后，我们将讨论尽管有指南推荐，但可能阻碍SGLT2-i在不同专科医生中广泛应用的一些因素。
