Khalid Noman, Afzal Muhammad Adil, Abdullah Muhammad, Haiy Ata-Ul, Shamoon Yezin, Elkattawy Sherif, Laghari Muhammad Aamir, Vasudev Rahul, Fayez Shamoon E, Rajeswaran Yasotha, Lanier Gregg M, Aronow Wilbert
Department of Internal Medicine, St. Joseph's University Medical Center, Paterson, NJ, USA.
Department of Public Health and Community Medicine, Shaikh Khalifa Bin Zayed Al Nahyan Medical and Dental College, Lahore, Pakistan.
Future Cardiol. 2025 Jun;21(7):495-501. doi: 10.1080/14796678.2025.2499374. Epub 2025 May 5.
Acute heart failure (AHF) is leading cause of hospitalization and mortality. Empagliflozin, a Sodium Glucose Co-transporter 2 inhibitor (SGLT-2i), has demonstrated benefits in HFrEF and HFpEF, but its role in AHF remains under-explored.
Assess safety and efficacy of empagliflozin in AHF.
A systematic review and meta-analysis adhering to PRISMA 2020 guidelines was conducted. A search on 25 February 2025, identified Phase IIb and III randomized controlled trials (RCTs) involving adults with AHF from databases like Medline®, Cochrane CENTRAL, Embase, and ClinicalTrials.gov. Outcomes included all-cause mortality, HF rehospitalization, cardiovascular deaths, and serious adverse events. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Heterogeneity was assessed with I2 and Cochrane Q-statistic.
Three RCTs ( = 824) were included. Empagliflozin reduced all-cause mortality (OR: 0.47, 95% CI: 0.29-0.78, = 0.004) and cardiovascular death (OR: 0.56, 95% CI: 0.38-0.82, = 0.003) compared to placebo. It also lowered serious adverse events risk (OR: 0.62, 95% CI: 0.44-0.87, = 0.005) without significantly increasing adverse effects such as acute kidney injury, diabetic ketoacidosis, hypotension, or urinary tract infections. Sensitivity analyses confirmed these findings.
Empagliflozin reduces mortality in AHF with a favorable safety profile, highlighting need for further trials.
急性心力衰竭（AHF）是住院和死亡的主要原因。恩格列净是一种钠-葡萄糖协同转运蛋白2抑制剂（SGLT-2i），已在射血分数降低的心力衰竭（HFrEF）和射血分数保留的心力衰竭（HFpEF）中显示出益处，但其在AHF中的作用仍有待探索。
评估恩格列净在AHF中的安全性和疗效。
按照PRISMA 2020指南进行系统评价和荟萃分析。于2025年2月25日进行检索，从Medline®、Cochrane CENTRAL、Embase和ClinicalTrials.gov等数据库中识别涉及成年AHF患者的IIb期和III期随机对照试验（RCT）。结局指标包括全因死亡率、心力衰竭再住院率、心血管死亡和严重不良事件。采用随机效应模型计算95%置信区间（CI）的比值比（OR）。用I²和Cochrane Q统计量评估异质性。
纳入三项RCT（n = 824）。与安慰剂相比，恩格列净降低了全因死亡率（OR：0.47，95%CI：0.29 - 0.78，P = 0.004）和心血管死亡（OR：0.56，95%CI：0.38 - 0.82，P = 0.003）。它还降低了严重不良事件风险（OR：0.62，95%CI：0.44 - 0.87，P = 0.005），且未显著增加急性肾损伤、糖尿病酮症酸中毒、低血压或尿路感染等不良反应。敏感性分析证实了这些结果。
恩格列净可降低AHF的死亡率，安全性良好，凸显了进一步试验的必要性。
