Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy.
Department of Cardiology, Ospedale Fabrizio Spaziani, 03100 Frosinone, Italy.
Int J Mol Sci. 2024 Oct 25;25(21):11458. doi: 10.3390/ijms252111458.
Heart failure (HF) is a complex syndrome that requires tailored and patient-centered treatment. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) constitute one of the four pillars of the medical treatment of HF. However, the 2023 ESC guidelines treat HF as a single entity without making clear distinctions in phenotypes according to etiology. This creates a "gap in knowledge", causing much debate about the applicability of these drugs in peculiar clinical settings that are etiological and/or predisposing clinical conditions for HF. Furthermore, considering the variety of etiologies and different pathophysiological backgrounds of HF, one might question whether the use of SGLT2is is equally beneficial in all types of HF and whether certain drug-related properties may be exploited in different contexts. For example, SGLT2is can improve the metabolic and inflammatory state, which is fundamental in ischemic heart disease. Anti-inflammatory power can also play a paramount role in myocarditis or cardiotoxicity, while improving the congestive state and reducing filling pressure may be even more fundamental in restrictive heart disease or advanced heart disease. This review aims to gather the evidence currently present in the literature concerning the advantages or the disadvantages of using these drugs in these particular clinical settings, with the goal being an optimized and highly personalized treatment for HF.
心力衰竭（HF）是一种复杂的综合征，需要量身定制和以患者为中心的治疗。钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2is）是 HF 治疗的四大支柱之一。然而，2023 年 ESC 指南将 HF 视为单一实体，而没有根据病因对表型进行明确区分。这造成了“知识空白”，导致人们对这些药物在 HF 的特殊临床环境中的适用性产生了很多争议，这些环境在病因学和/或易患 HF 的临床条件方面具有特殊性。此外，考虑到 HF 的病因多种多样，且具有不同的病理生理背景，人们可能会质疑 SGLT2is 在所有类型的 HF 中是否同样有益，以及某些与药物相关的特性是否可以在不同情况下得到利用。例如，SGLT2is 可以改善代谢和炎症状态，这在缺血性心脏病中至关重要。抗炎能力在心包炎或心肌毒性中也可能起着至关重要的作用，而改善充血状态和降低充盈压在限制性心脏病或晚期心脏病中可能更为重要。本综述旨在收集目前文献中关于在这些特定临床环境中使用这些药物的优缺点的证据，目标是为 HF 提供优化和高度个性化的治疗。
