钠-葡萄糖共转运蛋白 2 抑制剂对心脏结构重塑和功能的影响：一项随机对照试验的荟萃分析。

The effect of sodium-glucose cotransporter-2 inhibitors on cardiac structure remodeling and function: A meta-analysis of randomized controlled trials.

机构信息

Cardiology Department of Xianyang First People's Hospital, Xianyang, ShaanXi 712000, PR China.

出版信息

Eur J Intern Med. 2023 Aug;114:49-57. doi: 10.1016/j.ejim.2023.04.002. Epub 2023 Apr 14.

DOI:10.1016/j.ejim.2023.04.002

PMID:37062643

Abstract

BACKGROUND

It has been proven that sodium-glucose co-transporter 2 inhibitors (SGLT2is) improve the prognosis of patients with heart failure, independent of the presence of diabetes mellitus. Whether SGLT2 inhibitors affect cardiac structural remodeling and cardiac function is still uncertain.

METHODS

We included published randomized controlled trials (RCTs) to compare the effect of SGLT2is and control therapy in patients with or without heart failure. The meta-analysis was performed using Review Manager 5.3 software.

RESULTS

A total of 15 RCTs with a total of 1343 patients were selected for this meta-analysis, 663 of whom were on SGLT2is treatment and 680 of whom were in the control group. SGLT2is significantly improved heart rate (HR) [MD: -2.74, 95% CI (-4.71, -0.77), P = 0.006], left atrium volume index (LAVi) [MD: -1.99, 95% CI (-3.23,-0.75), P = 0.002], E/e' [MD: -1.47, 95% CI (-1.83,-1.10), P<0.00001], left ventricular mass index (LVMi) [MD: -2.38, 95% CI (-4.35, -0.40), P = 0.02], left ventricular end-systolic volume (LVESV) [MD: -6.50, 95% CI (-11.15,-1.84), P = 0.006], and left ventricular ejection fraction (LVEF) [MD: 1.78, 95% CI (0.56,3.01), P = 0.004] in the total population. Subgroup analysis indicated that compared with other SGLT2is, empagliflozin significantly decreased LVEDV, LVESV,LVMi, LAVi, E/e', and increased LVEF (P<0.05). In addition, the cardiac anti-remodeling effects of SGLT2 are particularly significant in patients with heart failure.

CONCLUSION

Our study showed that SGLT2is, particularly empagliflozin, significantly reverse cardiac remodeling in patients with heart failure. Empagliflozin may be a potentially promising agent to reverse cardiac remodeling in clinical practice.

摘要

背景

已有研究证实，钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2is）可改善心力衰竭患者的预后，且无论患者是否患有糖尿病均能获益。但 SGLT2 抑制剂是否影响心脏结构重塑和心功能仍不确定。

方法

我们纳入了比较 SGLT2is 与对照组治疗心力衰竭患者或非心力衰竭患者效果的已发表随机对照试验（RCT）。使用 Review Manager 5.3 软件进行荟萃分析。

结果

共纳入 15 项 RCT 总计 1343 例患者，其中 663 例患者接受 SGLT2is 治疗，680 例患者接受对照组治疗。SGLT2is 可显著降低心率（HR）[MD：-2.74，95%CI（-4.71，-0.77），P=0.006]、左心房容积指数（LAVi）[MD：-1.99，95%CI（-3.23，-0.75），P=0.002]、E/e'[MD：-1.47，95%CI（-1.83，-1.10），P<0.00001]、左心室质量指数（LVMi）[MD：-2.38，95%CI（-4.35，-0.40），P=0.02]、左心室收缩末期容积（LVESV）[MD：-6.50，95%CI（-11.15，-1.84），P=0.006]和左心室射血分数（LVEF）[MD：1.78，95%CI（0.56，3.01），P=0.004]。亚组分析表明，与其他 SGLT2is 相比，恩格列净可显著降低 LVEDV、LVESV、LVMi、LAVi、E/e'，并提高 LVEF（P<0.05）。此外，SGLT2 对心力衰竭患者的心脏抗重塑作用尤为显著。