Abstract 11978: Invasive Hemodynamic Changes Associated With Sodium Glucose Transporter-2 Inhibitors: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Introduction: Sodium-Glucose cotransporter-2 inhibitors (SGLT2i) have been shown to lower incident heart failure (HF) and HF hospitalizations, but the mechanism of benefits in relation to invasive hemodynamics remain unclear. This meta-analysis explores the central hemodynamic effects of SGLT2i. Methods: Using PRISMA guidelines, we systematically reviewed PubMed, Embase, CINAHL, Cochrane library, Ovid MEDLINE, and Google scholar from inception to April 2023 for randomized trials evaluating the effect of SGLT2i on central hemodynamics. Included patients were on guideline directed medical therapy and SGLT2i was added in the experimental group compared to placebo for 3-6 months. Rest and peak-exercise central hemodynamics was measured via right heart catheterization pre- and post-intervention. Random-effect model meta-analysis at 95% confidence interval (CI) was done using RevMan 5.4. Results: Out of 267 articles identified, 3 studies with a total of 145 patients were included in the meta-analysis. The mean age was 62.8 + 4.0 years, 70.0% were male and mean BMI was 31.9 + 2.2. Compared to placebo, SGLT2i were associated with reduction in weighted mean difference of pulmonary capillary wedge pressure (PCWP) by 2.71 (95% CI: -4.33 to -1.08, I 2 =2%, p = 0.001) and 4.17 (95% CI: -7.20 to -1.13, I 2 =0%, p = 0.007) mmHg at rest and peak exercise respectively. Similarly, SGLT2i reduced mean pulmonary artery pressure (mPAP) by 1.16 (95% CI: -3.00 to 0.69, I 2 =0%, p = 0.22) and 2.73 (95% CI: -5.63 to 0.18, I 2 =20%, p = 0.07) mmHg at rest and peak exercise respectively, however this was not statistically significant. Conclusions: SGLT2i significantly reduced PCWP at rest and peak exercise. Rest and peak exercise mPAP were also reduced compared to baseline but not statistically significant. This hypothesis-generating study offers mechanistic insights into the association of favorable hemodynamic effects underpinning to the HF benefits of SGLT2i.