| Objective:A meta-analysis of randomized controlled trials was performed to evaluate the impact of sodium-glucose transporter 2 inhibitor(SGLT-2 inhibitor)on cardiac function and cardiovascular outcomes in patients with heart failure.Methods:Domestic and foreign randomized controlled trials were manually searched from CNKY,Wanfang,VIP,Chinese Biomedical literature,Pub Med,Embase,Cochrane Library,Web of Science,and Clinical Trials.gov Library databases.The literature retrieval period was from the inception of the database until February,2022.According to the criteria of inclusion and exclusion,literatures were screened and valid data were extracted.Cochrane Risk Bias Scale was used to assessed the quality of included studies,Review Manager 5.4 and Stata 12.0 software were performed to analyze the data.Results:Finally,a total of 18 studies were enrolled and studied,involving 23366 patients.The results of meta-analysis as followed:(1)During the cardiac function indicators,patients in heart failure treated with SGLT-2 inhibitor further ameliorated the level of NT-pro BNP [SMD=-0.11,95% CI(-0.16,-0.06),P<0.01] and KCCQ scores [SMD=0.58,95% CI(0.02,1.13),P<0.05]versus conventional treatment.There was no statistical significance in left ventricular ejection fraction [SMD=0.47,95% CI(-0.06,1.00)] and 6-minute walking test[SMD=1.46,95% CI(-0.20,3.31)].(2)In terms of cardiovascular outcomes,the SGLT-2 inhibitor group further decreased the risk of hospitalization for heart failure [HR=0.69,95% CI(0.63,0.75),P<0.05],cardiovascular death [HR=0.87,95% CI(0.79,0.95),P<0.05],heart failure hospitalization or cardiovascular death [HR=0.75,95% CI(0.71,0.80),P<0.05],and all-cause death [HR=0.89,95% CI(0.82,0.96),P<0.05] compared with the control group.(3)During the different types of heart failure subgroups,compared to the control group,SGLT-2 inhibitor group led to a greater reduction in the level of NT-pro BNP[SMD=-0.10,95% CI(-0.16,-0.05),P<0.05;SMD=-0.18,95% CI(-0.34,-0.03),P<0.05] and the risk of heart failure hospitalization or cardiovascular death[HR=-0.31,95% CI(-0.40,-0.22),P<0.01;HR=-0.28,95% CI(-0.35,-0.21),P<0.01]among patients with reduced ejection fraction and preserved ejection fraction.(4)In the subgroups of different varieties of SGLT-2 inhibitors,the level of NT-pro BNP in dapagliflozin group was lower than control group among heart failure patients with reduced ejection fraction.Empagliflozin or dapagliflozin,or other varieties of SGLT-2 inhibitors in patients with failure,reduced the risk of hospitalization for heart failure [HR=0.7,95% CI(0.63,0.78);HR=0.71,95% CI(0.61,0.82);HR=0.6,95% CI(0.48,0.75)] and the combined event risk of heart failure hospitalization or cardiovascular death [HR=0.77,95% CI(0.70,0.84);HR=0.76,95% CI(0.68,0.85);HR=0.71,95% CI(0.61,0.82)],and the pooled analysis showed consistent benefits with approximate statistical significance.Conclusion:SGLT-2 inhibitors significantly reduce the level of NT-pro BNP,and the combined risk of hospitalization for heart failure or cardiovascular death in patients with reduced ejection fraction with or without preserved ejection fraction on the basis of conventional treatment,and different varieties of SGLT-2 inhibitors revealed clinical consistency in cardiovascular survival and prognostic benefits.SGLT-2inhibitors are applicable for a broad population of heart failure across the entire range of ejection fraction,which is worth further exploration in more clinical trials. |
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