AIMS To examine the effects of sodium-glucose cotransporter-2 inhibitors (SGLT2i) on cardiac remodelling in patients with type 2 diabetes mellitus (T2DM) and/or heart failure (HF), and to explore the subsets of patients who may have greater benefit from SGLT2i therapy. METHODS AND RESULTS Four electronic databases were searched for randomized controlled trials (RCTs) that evaluated the effects of SGLT2i on parameters reflecting cardiac remodelling in patients with T2DM and/or HF. Standardized mean differences (SMDs) or mean differences (MDs) were pooled. Subgroup analyses were performed according to the baseline HF and T2DM, HF type, SGLT2i agent, follow-up duration, and imaging modality. A total of 13 RCTs involving 1251 patients were analysed. Sodium-glucose cotransporter-2 inhibitors treatment significantly improved left ventricular (LV) ejection fraction [SMD, 0.35; 95% confidence interval (CI) (0.04, 0.65); P = 0.03], LV mass [SMD, -0.48; 95% CI (-0.79, -0.18); P = 0.002], LV mass index [SMD, -0.27; 95% CI (-0.49, -0.05); P = 0.02], LV end-systolic volume [SMD, -0.37; 95% CI (-0.71; -0.04); P = 0.03], LV end-systolic volume index [MD, -0.35 mL/m2; 95% CI (-0.64, -0.05); P = 0.02], and E-wave deceleration time [SMD, -0.37; 95% CI (-0.70, -0.05); P = 0.02] in the overall population. Subgroup analyses showed that the favourable effects of SGLT2i on LV remodelling were only significant in HF patients, especially HF with reduced ejection fraction (HFrEF), regardless of glycaemic status. Among the four included SGLT2i, empagliflozin was associated with a greater improvement of LV mass, LV mass index, LV end-systolic volume, LV end-systolic volume index, LV end-diastolic volume, and LV end-diastolic volume index (all P < 0.05). CONCLUSIONS Sodium-glucose cotransporter-2 inhibitors treatment significantly reversed cardiac remodelling, improving LV systolic and diastolic function, LV mass and volume, especially in patients with HFrEF and amongst those taking empagliflozin compared with other SGLT2i. Reversed remodelling may be a mechanism responsible for the favourable clinical effects of SGLT2i on HF.

中文翻译：

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钠-葡萄糖协同转运蛋白 2 抑制剂对心脏重塑的影响：系统评价和荟萃分析。

目的 研究钠-葡萄糖协同转运蛋白 2 抑制剂 (SGLT2i) 对 2 型糖尿病 (T2DM) 和/或心力衰竭 (HF) 患者心脏重塑的影响，并探索可能获益更大的患者亚群来自 SGLT2i 疗法。方法和结果 在四个电子数据库中搜索了随机对照试验 (RCT)，这些试验评估了 SGLT2i 对反映 T2DM 和/或 HF 患者心脏重构的参数的影响。汇集标准化平均差 (SMD) 或平均差 (MD)。根据基线 HF 和 T2DM、HF 类型、SGLT2i 药物、随访持续时间和成像方式进行亚组分析。共分析了涉及 1251 名患者的 13 项随机对照试验。钠-葡萄糖协同转运蛋白 2 抑制剂治疗显着改善了左心室 (LV) 射血分数 [SMD，0.35；95% 置信区间 (CI) (0.04, 0.65)；P = 0.03], LV 质量 [SMD, -0.48; 95% 置信区间 (-0.79, -0.18)；P = 0.002], LV 质量指数 [SMD, -0.27; 95% 置信区间 (-0.49, -0.05)；P = 0.02]，左室收缩末期容积 [SMD，-0.37；95% CI (-0.71; -0.04); P = 0.03]，左室收缩末期容积指数[MD，-0.35 mL/m2；95% 置信区间 (-0.64, -0.05)；P=0.02]，E波减速时间[SMD，-0.37；95% 置信区间 (-0.70, -0.05)；P = 0.02] 在总人口中。亚组分析表明，无论血糖状态如何，SGLT2i 对 LV 重构的有利影响仅在 HF 患者中显着，尤其是射血分数降低的 HF (HFrEF)。在包括 SGLT2i 在内的四种药物中，恩格列净与 LV 质量的更大改善相关，左室质量指数、左室收缩末期容积、左室收缩末期容积指数、左室舒张末期容积和左室舒张末期容积指数（均 P < 0.05）。结论 与其他 SGLT2i 相比，钠-葡萄糖协同转运蛋白 2 抑制剂治疗可显着逆转心脏重塑，改善 LV 收缩和舒张功能、LV 质量和容积，尤其是在 HFrEF 患者和服用 empagliflozin 的患者中。逆转重塑可能是 SGLT2i 对 HF 产生有利临床效果的机制。与其他 SGLT2i 相比，尤其是在 HFrEF 患者和服用恩格列净的患者中。逆转重塑可能是 SGLT2i 对 HF 产生有利临床效果的机制。与其他 SGLT2i 相比，尤其是在 HFrEF 患者和服用恩格列净的患者中。逆转重塑可能是 SGLT2i 对 HF 产生有利临床效果的机制。