SGLT2抑制剂预防和治疗心力衰竭:HFA和HFAI的科学声明

IF 3.7 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Marco Metra, Daniela Tomasoni, Marianna Adamo, Offer Amir, Stefan D Anker, Antoni Bayes-Genis, Michael Boehm, Javed Butler, Ovidiu Chioncel, Gerasimos Filippatos, Finn Gustafsson, Ewa A Jankowska, Juan Carlos Kaski, Brenda Moura, Mark C Petrie, Piotr Ponikowski, Amina Rakisheva, Arsen Ristic, Francois Roubille, Gianluigi Savarese, Petar Seferovic, Peter van der Meer, Maurizio Volterrani, Andrew J Coats, Vijay K Chopra, Giuseppe Rosano
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引用次数: 0

摘要

在2021年欧洲心脏病学会(ESC)心力衰竭(HF)指南中,钠-葡萄糖共转运蛋白2 (SGLT2)抑制剂被推荐用于2型糖尿病(T2DM)患者的HF预防和射血分数降低(HFrEF)的HF治疗。进一步的试验显示恩格列净和达格列净对保留射血分数(HFpEF)的HF患者有效。这些结果促使在2023年ESC HF指南的重点更新和其他国际指南中扩大了SGLT2抑制剂达格列净或依帕列净在整个左室射血分数(LVEF)谱上的推荐。在SOLOIST-WHF和EMPULSE中,索他列净(仅纳入T2DM患者)和恩帕列净分别在失代偿性心衰发作结束或发作后不久开始使用时是有益的。基于这些结果和早期出现的有益效果,急性心衰住院患者应尽早开始使用SGLT2抑制剂。在随机临床试验中,研究药物停药后的分析表明,停药后其益处可能迅速下降,因此,建议持续治疗。在EMPACT-MI中,恩格列净没有降低心血管(CV)死亡/心衰住院的主要结局,但减少了首次/复发性心衰住院。观察性研究已经报道了SGLT2抑制剂在其他特定疾病(如心脏淀粉样变性、成人先天性心脏病和小儿心衰患者)中的潜在益处,但需要前瞻性试验的证实。本科学声明总结了目前关于SGLT2抑制剂预防和治疗心衰作用的证据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
SGLT2 inhibitors for the prevention and treatment of heart failure: A scientific statement of the HFA and the HFAI.

In the 2021 European Society of Cardiology (ESC) heart failure (HF) guidelines, sodium-glucose cotransporter 2 (SGLT2) inhibitors were recommended for the prevention of HF in patients with type 2 diabetes mellitus (T2DM) and for the treatment of HF with reduced ejection fraction (HFrEF). Further trials showed efficacy of empagliflozin and dapagliflozin in patients with HF with preserved ejection fraction (HFpEF). These results prompted a broadened recommendation for the SGLT2 inhibitors dapagliflozin or empagliflozin across the whole left ventricular ejection fraction (LVEF) spectrum in the 2023 Focused Update of the ESC HF guidelines and in other international guidelines. In SOLOIST-WHF and EMPULSE, sotagliflozin (enrolling only patients with T2DM) and empagliflozin, respectively, were beneficial when initiated at the end or soon after an episode of decompensated HF. Based on these results and on the early appearance of their beneficial effects, the administration of SGLT2 inhibitors should start early in patients hospitalized for acute HF. Analyses after study drug withdrawal in randomized clinical trials have shown that their benefits may decline rapidly after discontinuation, and thus, persistence of treatment is advised. In EMPACT-MI, empagliflozin did not reduce the primary outcome of cardiovascular (CV) death/HF hospitalization but reduced first/recurrent HF hospitalizations. Potential benefits of SGLT2 inhibitors in further specific conditions (i.e., cardiac amyloidosis, grown-up congenital heart disease and paediatric patients with HF) have been reported in observational studies but need confirmation from prospective trials. This scientific statement summarizes current evidence regarding the effects of SGLT2 inhibitors for the prevention and treatment of HF.

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来源期刊
ESC Heart Failure
ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine
CiteScore
7.00
自引率
7.90%
发文量
461
审稿时长
12 weeks
期刊介绍: ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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