Saeed Amir, Younas Bilal, Rohan Ali, Haider Usman, Mukhtar Asad, Nazir Marriam
Acute Medicine, Norfolk and Norwich University Hospital, Norwich, GBR.
Cardiology, Mardan Medical Complex, Mardan, PAK.
Cureus. 2025 Jun 19;17(6):e86368. doi: 10.7759/cureus.86368. eCollection 2025 Jun.
Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome characterized by impaired ventricular filling and increased heart failure hospitalizations. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated cardiovascular and renal benefits in various heart failure populations, but their effects on HFpEF remain an area of growing interest. This study aims to evaluate the impact of SGLT2 inhibitors on key clinical outcomes in patients with HFpEF, including cardiovascular death, hospitalization for heart failure, exercise capacity, symptoms (as measured by the Kansas City Cardiomyopathy Questionnaire (KCCQ)), kidney disease progression, and other renal outcomes. A systematic review of randomized controlled trials (RCTs) assessing the effects of SGLT2 inhibitors (empagliflozin, dapagliflozin, sotagliflozin, canagliflozin, and ertugliflozin) in HFpEF patients was conducted. This systematic review was conducted per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) principles. The literature was searched using open-access, full-text English papers from January 2015 to April 2025 across PubMed, Embase, and the Cochrane Library. A total of 108 articles were retrieved through the initial search. After screening and checking for eligibility according to the pre-specified inclusion criteria, the methodological quality was assessed in 17 included studies using the Mixed Methods Appraisal Tool (MMAT) score. The MMAT Score 4 indicates a medium risk of bias (ROB), and the MMAT Score 5 indicates a low ROB. Ten studies had low ROB and were classified as "high quality." Seven had uncertain ROB, lowering the evidence by one point to "moderate quality," while one study had a high ROB. SGLT2 inhibitors were associated with significant reductions in cardiovascular death and heart failure-related hospitalizations. Improvements in KCCQ total symptom scores were observed, indicating enhanced patient-reported outcomes. The renal benefits of SGLT2 inhibitors were evident, with a reduction in kidney disease progression and a marked decrease in cardiovascular-related renal outcomes.
射血分数保留的心力衰竭（HFpEF）是一种复杂的综合征，其特征为心室充盈受损和心力衰竭住院率增加。钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂已在各类心力衰竭人群中显示出心血管和肾脏方面的益处，但其对HFpEF的影响仍是一个日益受到关注的领域。本研究旨在评估SGLT2抑制剂对HFpEF患者关键临床结局的影响，包括心血管死亡、因心力衰竭住院、运动能力、症状（通过堪萨斯城心肌病问卷（KCCQ）测量）、肾脏疾病进展以及其他肾脏结局。对评估SGLT2抑制剂（恩格列净、达格列净、索格列净、卡格列净和依鲁格列净）对HFpEF患者影响的随机对照试验（RCT）进行了系统评价。本系统评价按照系统评价和Meta分析的首选报告项目（PRISMA）原则进行。通过检索2015年1月至2025年4月期间PubMed、Embase和Cochrane图书馆的开放获取全文英文论文来查找文献。通过初步检索共检索到108篇文章。根据预先指定的纳入标准进行筛选和资格检查后，使用混合方法评估工具（MMAT）评分对17项纳入研究的方法学质量进行了评估。MMAT评分为4表示偏倚风险（ROB）中等，MMAT评分为5表示ROB较低。10项研究的ROB较低，被归类为“高质量”。7项研究的ROB不确定，证据等级降低一级至“中等质量”，而一项研究的ROB较高。SGLT2抑制剂与心血管死亡和心力衰竭相关住院的显著减少相关。观察到KCCQ总症状评分有所改善，表明患者报告的结局有所改善。SGLT2抑制剂的肾脏益处明显，肾脏疾病进展减少，心血管相关肾脏结局显著降低。
