Ricci Fabrizio, Saraullo Silvio, Boccatonda Andrea, Sorella Anna, Cipollone Alessia, Simeone Paola, Gallina Sabina, Santilli Francesca, Cipollone Francesco, D'Ardes Damiano
Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; University Cardiology Division, Heart Department, SS. Annunziata Polyclinic, Chieti, Italy; Institute for Advanced Biomedical Technologies, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy.
Department of Neuroscience, Imaging and Clinical Sciences, G. D'Annunzio University of Chieti-Pescara, 66100 Chieti, Italy.
Curr Probl Cardiol. 2025 Aug;50(8):103081. doi: 10.1016/j.cpcardiol.2025.103081. Epub 2025 May 30.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as transformative therapies in the management of chronic heart failure (HF), offering substantial reductions in mortality and hospitalizations. Beyond their initial classification as diuretics, SGLT2i exert a spectrum of cardioprotective effects that extend far beyond renal modulation. By activating autophagic pathways and mimicking a starvation-like state, SGLT2i enhance cellular bioenergetics and mitigate acute injury, potentially underpinning both their immediate and sustained cardiometabolic benefits when administered early in acute care settings. In acute decompensated HF, early initiation of SGLT2i enhances clinical decongestion by increasing diuresis, improving diuretic efficiency, and mitigating diuretic resistance, translating to shorter hospitalizations and reduced readmissions and mortality. In acute myocardial infarction, SGLT2i reduce the incidence of first and total HF hospitalizations, arrhythmic events, adverse cardiac remodelling, and contrast-induced acute kidney injury, while mitigating stent failure and atherosclerotic progression. Furthermore, they demonstrated efficacy in preventing new-onset and recurrent supraventricular and ventricular arrhythmias. However, the evidence remains inconclusive regarding their impact on sudden cardiac death or outcomes following cardiac arrest. In critically ill patients, SGLT2i use is associated with reduced rates of acute kidney injury and the need for renal replacement therapy, with promising implications for the management of sepsis and multi-organ dysfunction. Importantly, adverse effects such as renal impairment, electrolyte disturbances, acid-base imbalances, urinary tract infections, and dysglycemia appear infrequently in this population. This narrative review synthesizes the underlying pathophysiological mechanisms, current clinical evidence, and potential future applications of early SGLT2i therapy in acute care settings, providing insights into their expanding role in contemporary cardiovascular medicine.
钠-葡萄糖协同转运蛋白2抑制剂（SGLT2i）已成为慢性心力衰竭（HF）管理中的变革性疗法，可显著降低死亡率和住院率。除了最初被归类为利尿剂外，SGLT2i还具有一系列心脏保护作用，远远超出了肾脏调节的范畴。通过激活自噬途径并模拟饥饿样状态，SGLT2i增强细胞生物能量代谢并减轻急性损伤，这可能是其在急性护理环境中早期给药时产生即时和持续心脏代谢益处的潜在基础。在急性失代偿性HF中，早期启动SGLT2i可通过增加利尿、提高利尿效率和减轻利尿抵抗来增强临床消肿，从而缩短住院时间、减少再入院率和死亡率。在急性心肌梗死中，SGLT2i可降低首次和总HF住院率、心律失常事件、不良心脏重塑以及造影剂诱导的急性肾损伤的发生率，同时减轻支架失败和动脉粥样硬化进展。此外，它们在预防新发和复发性室上性和室性心律失常方面也显示出疗效。然而，关于它们对心源性猝死或心脏骤停后结局的影响，证据仍不确凿。在危重症患者中，使用SGLT2i与急性肾损伤发生率降低以及肾脏替代治疗需求减少相关，这对脓毒症和多器官功能障碍的管理具有潜在意义。重要的是，在这一人群中，诸如肾功能损害、电解质紊乱、酸碱失衡、尿路感染和血糖异常等不良反应并不常见。本叙述性综述综合了早期SGLT2i治疗在急性护理环境中的潜在病理生理机制、当前临床证据以及潜在的未来应用，深入探讨了它们在当代心血管医学中不断扩大的作用。
