Sattar Saba, Yadav Mansi, Maisuriya Ankitakumari B, Ogunfunwa Olamide, Satti Ahmad Bin Abdul Qayyum, Ali Husnain, Mushtaq Muhammad Muaz, Amjad Saba, Hussain Azlaan, Kolanu Nikhil Deep
Medicine, King Edward Medical University, Lahore, PAK.
Internal Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND.
Cureus. 2025 May 13;17(5):e84026. doi: 10.7759/cureus.84026. eCollection 2025 May.
Heart failure with preserved ejection fraction (HFpEF) represents a significant clinical challenge due to its complex pathophysiology and limited therapeutic options. This systematic review evaluates the efficacy and safety of empagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, in patients with HFpEF. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we analyzed 11 studies, predominantly from the EMPEROR-Preserved trial and its sub-analyses, investigating empagliflozin in HFpEF patients. Our findings consistently demonstrate that empagliflozin significantly reduces heart failure hospitalizations (HR 0.71, 95% CI 0.60-0.83) across diverse patient populations. This benefit was observed regardless of sex, age, diabetes status, blood pressure, and frailty levels, although effects were attenuated in patients with higher ejection fractions and in severely frail individuals. Notably, empagliflozin did not significantly reduce cardiovascular mortality, although a non-significant trend toward benefit was observed in certain subgroups. Additional benefits included slowed decline in renal function and improved quality of life measures. The safety profile was favorable across all studies, with good tolerability even in elderly and frail populations. These findings position empagliflozin as a valuable addition to the limited therapeutic armamentarium for HFpEF, particularly for reducing hospitalizations and improving symptoms, though its impact on mortality appears limited. Future research should focus on identifying specific HFpEF phenotypes that derive maximal benefit from empagliflozin and evaluating its long-term efficacy, optimal combination strategies, and real-world effectiveness across diverse populations.
射血分数保留的心力衰竭（HFpEF）因其复杂的病理生理学和有限的治疗选择而成为一项重大的临床挑战。本系统评价评估了钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂恩格列净在HFpEF患者中的疗效和安全性。按照系统评价和Meta分析的首选报告项目（PRISMA）指南，我们分析了11项研究，主要来自EMPEROR-Preserved试验及其亚分析，这些研究对HFpEF患者使用恩格列净进行了调查。我们的研究结果一致表明，恩格列净在不同患者群体中均能显著降低心力衰竭住院率（风险比0.71，95%置信区间0.60-0.83）。无论性别、年龄、糖尿病状态、血压和虚弱程度如何，均观察到这一益处，尽管在射血分数较高的患者和严重虚弱的个体中效果有所减弱。值得注意的是，恩格列净并未显著降低心血管死亡率，尽管在某些亚组中观察到了不显著的获益趋势。其他益处包括肾功能下降减缓以及生活质量指标改善。在所有研究中，安全性概况良好，即使在老年和虚弱人群中也具有良好的耐受性。这些研究结果表明，恩格列净是HFpEF有限治疗手段中的一项有价值的补充，特别是对于减少住院和改善症状，尽管其对死亡率的影响似乎有限。未来的研究应侧重于确定能从恩格列净中获得最大益处的特定HFpEF表型，并评估其长期疗效、最佳联合策略以及在不同人群中的实际效果。
