Escobar Carlos, Pascual-Figal Domingo, Manzano Luis, Nuñez Julio, Camafort Miguel
Cardiology Department, University Hospital La Paz, 28046 Madrid, Spain.
Cardiology Department, Hospital Clinico Universitario Virgen de la Arrixaca, 30120 Murcia, Spain.
J Clin Med. 2023 Oct 27;12(21):6798. doi: 10.3390/jcm12216798.
Heart failure (HF) is associated with a high morbidity and mortality burden. In light of more recent evidence, SGLT2 inhibitors are currently recommended as first-line therapy in managing patients with HF, regardless of ejection fraction, to reduce HF burden. The DAPA-HF and DELIVER trials, and particularly, the pooled analysis of both studies, have shown that dapagliflozin significantly reduces the risk of cardiovascular death, all-cause death, total HF hospitalizations, and MACE in the whole spectrum of HF, with sustained benefits over time. Recent data have shown that the full implementation of dapagliflozin in clinical practice would translate into a robust reduction in hospitalizations for HF and death in real-life populations. Many pathophysiological mechanisms have been involved in these benefits, particularly the positive effects of dapagliflozin on reversing cardiac (atrial and ventricular) remodeling, reducing cardiac fibrosis and inflammation, and improving endothelial dysfunction. In this manuscript, we reviewed from a practical point of view the role of dapagliflozin in the management of the whole spectrum of patients with HF.
心力衰竭（HF）与高发病率和高死亡率负担相关。鉴于最新证据，目前推荐钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂作为治疗HF患者的一线疗法，无论射血分数如何，以减轻HF负担。达格列净治疗心力衰竭研究（DAPA-HF）和达格列净治疗射血分数降低的心力衰竭患者研究（DELIVER）试验，特别是两项研究的汇总分析表明，达格列净显著降低了整个HF谱中的心源性死亡、全因死亡、HF住院总数和主要不良心血管事件（MACE）的风险，且随着时间推移具有持续益处。近期数据表明，在临床实践中全面应用达格列净将切实减少HF住院率和现实人群中的死亡率。这些益处涉及多种病理生理机制，特别是达格列净在逆转心脏（心房和心室）重塑、减少心脏纤维化和炎症以及改善内皮功能障碍方面的积极作用。在本手稿中，我们从实际角度综述了达格列净在整个HF患者谱管理中的作用。
