Imaging-based Demonstration of Reverse Left Heart Remodeling after Sodium-Glucose Co-transporter 2 Inhibitors in Heart Failure: A Systematic Review and Meta-analysis.

BACKGROUND

Several studies have demonstrated the safety and efficacy of sodium-glucose co-transporter 2 inhibitors (SGLT2i), but there is little evidence on how these drugs improve cardiac remodeling parameters in patients with heart failure (HF). We performed a meta-analysis of RCTs to evaluate the effect of SGLT2i on cardiac remodeling in patients with HF. The study protocol was registered in June 2025 (PROSPERO: CRD420251055562).

METHODS

The Medline, Scopus, and Cochrane Central databases were searched for RCTs that compared SGLT2i with placebo in patients ≥18 years of age with a diagnosis of HF. Eleven outcomes were analyzed, including left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVES), left ventricular mass (LVM), left ventricular ejection fraction (LVEF), left atrial volume indexed (LAVi), left ventricular global longitudinal Strain, stroke volume, and E/e'. Statistical analyses were performed using R version 4.3.2.

RESULTS

We included 13 RCTs with 1181 patients, 592 of whom received SGLT2i as the intervention. LVEDV (MD: -8.41 mL; 95% CI: -13.07 to - 3.75, P = 0.004), LVES (MD: -8.11 mL; 95% CI: -13.95 to -2.28, P = 0,006), left ventricular end-systolic volume indexed (LVESVi) (MD: -3.71 mL/m2, 95% CI: -6.84 to - 0.58, P = 0.02), LVM (MD: -7.65 g; 95% CI: -13.79 to -1.51, P = 0.01), and LAVi (MD: -2.04 ml/m2; 95% CI: -3.21 to - 0.86, P = 0.0007) were significantly lower in patients treated with SGLT2i compared to placebo. In addition, this treatment led to a significant increase in LVEF (MD: +2.59%, 95% CI: 1.76 to 3.43, P < 0.00001) compared to placebo.

CONCLUSION

Our results suggest that in patients with HF, SGLT2i have a positive influence on cardiac remodeling since they lead to a significant decrease in LVEDV, LVES, LVESVi, LVM, left ventricular mass indexed, and LAVi compared to placebo and a significant increase in EF.