The Effects Of SGLT2 Inhibitors On Cardiac Function In Patients With Heart Failure With Preserved Ejection Fraction:A Meta-analysis

Objective:Heart failure with preserved ejection fraction(HFp EF)is a growing disease burden that affects more than half of all heart failure patients.Research has found that SGLT2 inhibitors play a beneficial role in improving all-cause mortality,heart failure readmission,and cardiovascular mortality risk in HFp EF patients.However,the impact of SGLT2 inhibitors on some indicators of cardiac function in HFp EF patients,such as BNP and E/e ratio,is still unclear.Therefore,this study systematically evaluated the effects of SGLT2 inhibitors on cardiac function in HFp EF patients with or without type 2diabetes(T2DM).Methods:Systematic searches were conducted in Chinese databases(China Knowledge Network,Wan fang Database,Vip Database,CBM databases)and English databases(Pub Med,Embase,Web of science,The Cochrane Library),with no language restrictions,for data from randomized controlled trials of SGLT2 inhibitors in patients with HFp EF with or without T2DM(the search time frame for all databases was set to build up to 31 January 2023).After data screening and extraction by two researchers,the quality of the selected literatures was assessed using Cochrane bias risk assessment tool.Review Manager 5.4.1 software was used to analyze the results of the included studies,and publication bias analysis and sensitivity analysis were carried out.Results:A total of 10 eligible studies included 1887 HFp EF patients with or without T2 DM.The results of this meta-analysis showed that the SGLT2 inhibitor treatment group reduced the E / e? ratio(MD=-0.68,95% CI: [-1.34,-0.03],p<0.05)and improved the6-minute walk distance in heart failure patients(MD=16.90,95%CI:[11.45,22.36],p<0.00001)compared to the control group or other drugs for glycaemia control.There were no significant effects in the SGLT2 inhibitor treatment group on left ventricular ejection fraction,plasma BNP and NT-pro BNP levels,left ventricular mass index and left ventricular end-diastolic volume.The results of both the risk of bias and sensitivity studies showed no publication bias and stable results.Conclusion:Existing data indicate that SGLT2 inhibitors significantly improve cardiac diastolic function in HFp EF patients with or without T2 DM,and that HFp EF patients show a significant increase in exercise tolerance and improved quality of life.In the future,it is still necessary to further explore the effects of SGLT2 inhibitors on cardiac function and their potential mechanisms.