BACKGROUND Although a variety of antidiabetic drugs have significant protective action on the cardiovascular system, it is still unclear which antidiabetic drugs can improve ventricular remodeling and fundamentally delay the process of heart failure. The purpose of this network meta-analysis is to compare the efficacy of sodium glucose cotransporter type 2 (SGLT-2) inhibitors, dipeptidyl peptidase-4 (DPP-4) inhibitors, glucagon-like peptide-1 (GLP-1) agonists, metformin (MET), sulfonylurea (SU) and thiazolidinediones (TZDs) in improving left ventricular (LV) remodeling in patients with type 2 diabetes (T2DM) and/or cardiovascular disease (CVD). METHODS We searched articles published before October 18, 2019, regardless of language or data, in 4 electronic databases: PubMed, EMBASE, Cochrane Library and Web of Science. We included randomized controlled trials in this network meta-analysis, as well as a small number of cohort studies. The differences in the mean changes in left ventricular echocardiographic parameters between the treatment group and control group were evaluated. RESULTS The difference in the mean change in LV ejection fraction (LVEF) between GLP-1 agonists and placebo in treatment effect was greater than zero (MD = 2.04% [0.64%, 3.43%]); similar results were observed for the difference in the mean change in LV end-diastolic diameter (LVEDD) between SGLT-2 inhibitors and placebo (MD = - 3.3 mm [5.31, - 5.29]), the difference in the mean change in LV end-systolic volume (LVESV) between GLP-1 agonists and placebo (MD = - 4.39 ml [- 8.09, - 0.7]); the difference in the mean change in E/e' between GLP-1 agonists and placebo (MD = - 1.05[- 1.78, - 0.32]); and the difference in the mean change in E/e' between SGLT-2 inhibitors and placebo (MD = - 1.91[- 3.39, - 0.43]). CONCLUSIONS GLP-1 agonists are more significantly associated with improved LVEF, LVESV and E/e', SGLT-2 inhibitors are more significantly associated with improved LVEDD and E/e', and DPP-4 inhibitors are more strongly associated with a negative impact on LV end-diastolic volume (LVEDV) than are placebos. SGLT-2 inhibitors are superior to other drugs in pairwise comparisons.

中文翻译：

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抗糖尿病药对左心室功能/功能障碍的影响：系统评价和网络荟萃分析。

背景技术尽管多种抗糖尿病药对心血管系统具有显着的保护作用，但仍不清楚哪种抗糖尿病药可以改善心室重构并从根本上延缓心力衰竭的进程。此网络荟萃分析的目的是比较2型钠葡萄糖共转运蛋白（SGLT-2）抑制剂，二肽基肽酶4（DPP-4）抑制剂，胰高血糖素样肽1（GLP-1）激动剂的功效，二甲双胍（MET），磺酰脲（SU）和噻唑烷二酮（TZD）在改善2型糖尿病（T2DM）和/或心血管疾病（CVD）患者的左心室（LV）重塑中的作用。方法我们在4个电子数据库（PubMed，EMBASE，Cochrane图书馆和Web of Science）中搜索了2019年10月18日之前发表的文章，无论其语言或数据如何。我们在该网络荟萃分析中包括随机对照试验，以及少量的队列研究。评估了治疗组和对照组之间左心室超声心动图参数的平均变化的差异。结果GLP-1激动剂和安慰剂之间的LV射血分数（LVEF）平均变化在治疗效果上的差异大于零（MD = 2.04％[0.64％，3.43％]）；对于SGLT-2抑制剂和安慰剂之间的LV舒张末期直径（LVEDD）的平均变化的差异（MD =-3.3 mm [5.31，-5.29]），LV端的平均变化的差异也观察到了相似的结果GLP-1激动剂和安慰剂之间的收缩压（LVESV）（MD =-4.39 ml [-8.09，-0.7]）；GLP-1激动剂和安慰剂之间E / e'的平均变化的差异（MD =-1.05 [-1.78，-0.32]）；以及SGLT-2抑制剂和安慰剂之间E / e'的平均变化的差异（MD =-1.91 [-3.39，-0.43]）。结论GLP-1激动剂与改善的LVEF，LVESV和E / e'关联更明显，SGLT-2抑制剂与改善的LVEDD和E / e'关联更明显，而DPP-4抑制剂与负面影响更密切相关左室舒张末期容积（LVEDV）高于安慰剂。在成对比较中，SGLT-2抑制剂优于其他药物。与安慰剂相比，DPP-4和DPP-4抑制剂对LV舒张末期容积（LVEDV）的负面影响更强烈。在成对比较中，SGLT-2抑制剂优于其他药物。与安慰剂相比，DPP-4和DPP-4抑制剂对LV舒张末期容积（LVEDV）的负面影响更强烈。在成对比较中，SGLT-2抑制剂优于其他药物。