Efficacy Of SGLT-2 Inhibitors In Heart Failure With Mildly Reduced Or Preserved Ejection Fraction: A Meta-Analysis

Objective:To evaluate the efficacy of sodium-glucose co-transporter-2(SGLT-2)inhibitors in patients with heart failure with mildly reduced or preserved ejection fraction.Methods:We searched the following electronic databases with computer system:Pub Med,EMbase,The Cochrane Library,Web of Science,etc.The time was from database creation to December 25,2022.We searched the RCT literature of SGLT-2 inhibitors in patients with heart failure with mildly reduced or preserved ejection fraction.Qbserved outcomes included the compound risk of cardiovascular death or heart failure hospitalization,the risk of heart failure hospitalization,the risk of cardiovascular death,the risk of all-cause death,the 6-minute walking test,and any serious adverse events.The Review Manager software 5.3 was used for meta-analysis.The evaluation of publication bias and sensitivity analysis for the included articles were performed by Stata14.0 and Stata16.0.Results:A total of 8 RCTs with a total of 16 628 patients were included.Compared with the placebo,the treatment of SGLT-2 inhibitor group significantly reduced the compound risk of cardiovascular death or heart failure hospitalization[HR=0.79,95%CI(0.72～0.85),P<0.00001,I~2=0%],and this was consistent in subgroup analysis including left ventricular ejection fraction,gender,age>65years,body mass index,whether or not combined with diabetes mellitus,and whether it is complicated with atrial fibrillation.The risk of heart failure hospitalization reduced[HR=0.74,95%CI(0.67～0.82),P<0.00001,I~2=0%].No reduction in risk of cardiovascular death[HR=0.92,95%CI(0.82～1.04),P=0.19,I~2=6%].No change in risk of all-cause mortality[OR=0.97,95%CI(0.88～1.06),P=0.46,I~2=0%].The 6-minute walking distance has also improved[MD=16.67,95%CI(5.16～28.18),P=0.005,I~2=0%].The incidence of any serious adverse events significantly lowered in the SGLT-2 inhibitor group[OR=0.89,95%CI(0.83～0.96),P=0.002,I~2=0%].Conclusion:Theresultsofthis meta-analysis confirmed that treatment with the SGLT-2 inhibitors,regardless of T2DM,can reduce the compound risk of cardiovascular death or heart failure hospitalization and can reduce heart failure hospitalization.The risk of cardiovascular mortality and all-cause mortality.did not reduce.The 6-minute walking distance improved.Low incidence of any serious adverse events.