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Background <p>Stage A and B heart failure (HF) in type 2 diabetes (T2DM) represents a critical window for prevention. Although SGLT2 inhibitors (SGLT2i) are recommended for early HF risk reduction, their direct structural effects on pre-symptomatic myocardium remain insufficiently characterized in this population.</p> Methods <p>MEDLINE, Cochrane Central, Scopus, and ClinicalTrials.gov were searched from inception to February 2026 for studies comparing SGLT2i with placebo in T2DM with Stage A and B HF. Risk of bias was assessed with RoB 2.0. R (version4.5.2) was used to analyse outcomes. Certainty of evidence was assessed using GRADE.</p> Results <p>Ten trials (<i>n</i> = 773) showed significant reductions in LV mass (–3.37&#xa0;g), LVMI (–1.84&#xa0;g/m²) and E/e′ (–0.81). SGLT2i improved weight, BMI, HbA1c, and systolic blood pressure. Safety outcomes were favorable, with no diabetic ketoacidosis reported.</p> Conclusions <p>SGLT2i use was associated with a significant reduction in LV mass and improvements in filling pressures, suggesting a favorable modification of underlying myocardium in Stage A and B HF. These changes likely reflect hemodynamic unloading and mass regression rather than immediate functional recovery.</p>

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Effects of SGLT2 inhibitors on cardiac structure and function in stage A and B heart failure with type 2 diabetes: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月23日

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  • Vishwani Khanna,
  • Aarushi Batra,
  • Ashok Kumar,
  • Samragyi Juneja,
  • Abhishek Pandeya

摘要

Background

Stage A and B heart failure (HF) in type 2 diabetes (T2DM) represents a critical window for prevention. Although SGLT2 inhibitors (SGLT2i) are recommended for early HF risk reduction, their direct structural effects on pre-symptomatic myocardium remain insufficiently characterized in this population.

Methods

MEDLINE, Cochrane Central, Scopus, and ClinicalTrials.gov were searched from inception to February 2026 for studies comparing SGLT2i with placebo in T2DM with Stage A and B HF. Risk of bias was assessed with RoB 2.0. R (version4.5.2) was used to analyse outcomes. Certainty of evidence was assessed using GRADE.

Results

Ten trials (n = 773) showed significant reductions in LV mass (–3.37 g), LVMI (–1.84 g/m²) and E/e′ (–0.81). SGLT2i improved weight, BMI, HbA1c, and systolic blood pressure. Safety outcomes were favorable, with no diabetic ketoacidosis reported.

Conclusions

SGLT2i use was associated with a significant reduction in LV mass and improvements in filling pressures, suggesting a favorable modification of underlying myocardium in Stage A and B HF. These changes likely reflect hemodynamic unloading and mass regression rather than immediate functional recovery.