Sodium-Glucose Cotransporter 2 Inhibitors and Left Ventricular Function

Left ventricular (LV) function improved with sodium-glucose cotransporter 2 (SGLT2) inhibitor therapy in people with or without type 2 diabetes (T2D), especially in those with heart failure or receiving empagliflozin therapy. These findings were published in the Journal of Clinical Endocrinology & Metabolism.

Researchers from Shanghai Jiao Tong University School of Medicine in China searched medical literature databases for studies of SGLT2 inhibitor treatment among patients with diabetes or heart failure for this systematic review and meta-analysis. A total of 13 studies of randomized clinical trials (n=7) and cohort studies (n=6) were included.

Of the 1437 patients from the 13 studies analyzed, more than half experienced heart failure (n=783) and all but 84 had diabetes. They received SGLT2 inhibitors (n=830) or not (n=607). Patients in the 7 randomized clinical trials received placebo. In the 6 cohort studies, patients in 5 of these studies received various antidiabetic agents, and one received dipeptidyl peptidase-4 inhibitors.

Overall, there was no effect of SGLT2 inhibitors on LV mass index, however among only the cohort studies (WMD, -17.600; 95% CI, -29.538 to -5.662 g/m²; I², 0%) or those that used empagliflozin (WMD, -4.330; 95% CI, -7.776 to -0.884 g/m²; I², 53.7%) an effect was observed.

For LV ejection fraction, a significant effect was observed (WMD, 2.458%; 95% CI, 0.693%-4.224%; I², 75.6%). LV end-diastolic volume to body surface area was reduced compared with other drugs (WMD, -9.134; 95% CI, -15.808 to -2.460 mL; I², 69.1%). The effect was significant for empagliflozin (WMD, -13.091; 95% CI, -21.303 to -4.880 mL; I², 70.1%) but not dapagliflozin (WMD, -1.081; 95% CI, -6.397 to 4.234 mL; I², 0%). No effect for LV end-diastolic volume to body surface area index was observed (WMD, -3.675; 95% CI, -7.837 to 0.486 mL/m²; I², 53.6%).

LV end-systolic volume to body surface area was also significantly reduced (WMD, -8.440; 95% CI, -15.093 to -1.787 mL; I², 82.7%) with no overall effect on LV end-systolic volume to body surface area index (WMD, -2.782; 95% CI, -5.612 to 0.048 mL/m²; I², 39.3%).

SGLT2 inhibitors were also observed to effect on effect left atrium volume index (WMD, -2.791; 95% CI, -4.554 to -1.027 mL/m²; I², 0%) and E/e’ (WMD, -1.567; 95% CI, -2.440 to -0.698 mL/m²; I², 18.5%)

Researchers acknowledged several study limitations, including a relatively small number of participants and moderate heterogeneity in some comparisions.

The study authors concluded that SGLT2 inhibitor therapy improved LV function improved among patients with or without diabetes.

Reference

Shi F-H, Li H, Shen L, et al. Beneficial effect of sodium-glucose co-transporter 2 inhibitors on left ventricular function. J Clin Endocrinol Metab. doi:10.1210/clinem/dgab834