钠-葡萄糖共转运蛋白2抑制剂对心脏淀粉样变性患者死亡率和去充血的影响：一项系统综述和荟萃分析。

IF 3.3 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Current Problems in Cardiology Pub Date : 2025-06-18 DOI:10.1016/j.cpcardiol.2025.103100

Christiane Santo M.D. , Cristhian Romero M.D. , Bruno Vaz Kerges Bueno M.D. , Andre Dabarian P.H.D. , José Nativi Nicolau P.H.D. , Fabio Fernandes P.H.D.

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引用次数: 0

摘要

背景：虽然钠葡萄糖共转运蛋白2抑制剂（SGLT2i）已被证实对保留射血分数（HFpEF）的心力衰竭有益处，但它们在转甲状腺素型心脏淀粉样变性（atr - ca）中的作用仍不确定。该荟萃分析评估了SGLT2i在ATTR-CA患者中的疗效和安全性，该人群被排除在关键试验之外。材料和方法：遵循PRISMA指南，我们系统地检索了PubMed/Embase/Cochrane到2024年12月评估心脏淀粉样变性中SGLT2i的研究。主要结局包括全因死亡率、心血管死亡率、NT-proBNP水平和住院率。采用95%置信区间（ci）的风险比（RR）和危险比（HR）对分类终点的治疗效果进行比较。比较连续结局的平均差异（MD）。结果：5项观察性研究(5101例患者；2528例SGLT2i和2573例对照)符合纳入标准。SGLT2i的使用与全因死亡率显著降低相关（RR 0.37, 95% CI 0.28-0.49, p2=0%）。大多数研究具有中等偏倚风险，主要来自回顾性设计和选择偏倚。结论：在atr - ca患者中，SGLT2i与死亡率相对风险降低63-70%、心脏生物标志物和住院率改善相关。虽然有希望，但这些观察结果需要在随机试验中得到证实，以解决潜在的混杂因素。

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Impact of sodium- glucose co-transporter 2 inhibitors in mortality and Decongestion in cardiac amyloidosis: A systematic review and meta-analysis

Background

While Sodium glucose Co-transporter 2 inhibitors (SGLT2i) show proven benefits in heart failure with preserved ejection fraction (HFpEF), their role in transthyretin cardiac amyloidosis (ATTR-CA) remains uncertain. This meta-analysis evaluates SGLT2i efficacy and safety specifically in ATTR-CA patients, a population excluded from pivotal trials.

Materials and Methods

Following PRISMA guidelines, we systematically searched PubMed/Embase/Cochrane through December 2024 for studies assessing SGLT2i in cardiac amyloidosis. Primary outcomes included all-cause mortality, cardiovascular mortality, NT-proBNP levels, and hospitalizations. Risk Ratios (RR) and Hazard Ratios (HR) with 95 % confidence intervals (CIs) were used to compare treatment effects for categorical endpoints. Continuous outcomes were compared with mean differences (MD).

Results

Five observational studies (5101 patients; 2528 SGLT2i vs 2573 controls) met inclusion criteria. SGLT2i use was associated with significantly lower all-cause mortality (RR 0.37, 95 % CI 0.28-0.49, p < 0.00001, I²=12 %) and cardiovascular mortality (RR 0.30, 0.16-0.55, p < 0.00001, I²=25 %). NT-proBNP levels were significantly reduced (MD -299.66 pg/mL, -493.24 to -106.08, p = 0.002, I²=0 %) and hospitalization rates were significantly lower (HR 0,59, 95 %CI 0,38-0,90; p = 0,01, I²=0 %). Most studies had moderate bias risk, primarily from retrospective designs and selection bias.

Conclusions

In ATTR-CA patients, SGLT2i were associated with 63-70 % relative risk reduction in mortality and improved cardiac biomarkers and hospitalization rates. While promising, these observational findings require confirmation in randomized trials to address potential confounding factors.

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来源期刊

Current Problems in Cardiology 医学-心血管系统

CiteScore

4.80

自引率

2.40%

发文量

392

审稿时长

6 days

期刊介绍： Under the editorial leadership of noted cardiologist Dr. Hector O. Ventura, Current Problems in Cardiology provides focused, comprehensive coverage of important clinical topics in cardiology. Each monthly issues, addresses a selected clinical problem or condition, including pathophysiology, invasive and noninvasive diagnosis, drug therapy, surgical management, and rehabilitation; or explores the clinical applications of a diagnostic modality or a particular category of drugs. Critical commentary from the distinguished editorial board accompanies each monograph, providing readers with additional insights. An extensive bibliography in each issue saves hours of library research.