Siddiqui Hasan Fareed, Waqas Saad Ahmed, Batool Ruqiat Masooma, Salim Hussain, Minhas Abdul Mannan Khan, Hasni Syed Farhan, Alsaid Amro, Sannino Anna, Afzal Aasim M, Khan Muhammad Shahzeb
Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Heart Fail Rev. 2025 May 21. doi: 10.1007/s10741-025-10523-0.
Glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown promising effects on heart failure (HF) outcomes, particularly in phenotype-specific populations. However, their impact on cardiac structure and function in HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) remains unclear.
Medline, Cochrane Library, and Scopus were queried through December 2024 for primary and secondary analyses of randomized controlled trials comparing GLP-1RA with placebo in HF patients. Outcomes included changes in left ventricular ejection fraction (LVEF), end-diastolic volume (LVEDV), end-systolic volume (LVESV), global longitudinal strain (GLS), left ventricular mass, left atrial volume (LAV), and NT-proBNP levels. Random-effects models were used to calculate weighted mean differences (WMDs) or hazard ratios (HRs).
Six trials (n = 1,195) were included, with three each evaluating HFpEF and HFrEF populations. In patients with HFpEF, GLP-1RA significantly reduced the LV mass (WMD: -8.6 g; 95% CI: -14.6, -2.6; p = 0.005) and LAV (WMD: -5.4 ml; 95% CI: -8.8, -2.0; p = 0.002) and lowered NT-proBNP concentration throughout (HR: 0.85; 95% CI: 0.8, 0.9; p < 0.001). A decrease in LAV was observed in the HFrEF population (WMD: -5.4 ml [95% CI: -8.8, -2.0]; p = 0.002). However, no significant improvements were observed in LVEF, LVEDV, LVESV, or GLS. There were significant differences between HFpEF and HFrEF for LVEDV (p = 0.01) and LVESV (p = 0.04).
GLP-1RA demonstrated phenotype-specific benefits, improving structural remodeling in HFpEF but showing limited effects in HFrEF. These findings highlight the importance of targeted therapeutic strategies based on HF phenotypes. Further research is warranted to elucidate underlying mechanisms and optimize patient selection.
胰高血糖素样肽-1受体激动剂（GLP-1RA）已显示出对心力衰竭（HF）结局有良好效果，尤其是在特定表型人群中。然而，它们对射血分数保留的心力衰竭（HFpEF）和射血分数降低的心力衰竭（HFrEF）患者心脏结构和功能的影响仍不清楚。
检索截至2024年12月的Medline、Cochrane图书馆和Scopus数据库，以获取比较HF患者中GLP-1RA与安慰剂的随机对照试验的一级和二级分析。结局指标包括左心室射血分数（LVEF）、舒张末期容积（LVEDV）、收缩末期容积（LVESV）、整体纵向应变（GLS）、左心室质量、左心房容积（LAV）和NT-proBNP水平的变化。采用随机效应模型计算加权平均差（WMD）或风险比（HR）。
纳入六项试验（n = 1195），其中三项分别评估HFpEF和HFrEF人群。在HFpEF患者中，GLP-1RA显著降低左心室质量（WMD：-8.6 g；95%CI：-14.6，-2.6；p = 0.005）和LAV（WMD：-5.4 ml；95%CI：-8.8，-2.0；p = 0.002），并持续降低NT-proBNP浓度（HR：0.85；95%CI：0.8，0.9；p < 0.001）。在HFrEF人群中观察到LAV降低（WMD：-5.4 ml [95%CI：-8.8，-2.0]；p = 0.002）。然而，LVEF、LVEDV、LVESV或GLS未观察到显著改善。HFpEF和HFrEF在LVEDV（p = 0.01）和LVESV（p = 0.04）方面存在显著差异。
GLP-1RA显示出特定表型的益处，改善了HFpEF的结构重塑，但在HFrEF中效果有限。这些发现凸显了基于HF表型的靶向治疗策略的重要性。有必要进一步研究以阐明潜在机制并优化患者选择。
