Efficacy and Safety of Sodium-Glucose Cotransporter 2 Inhibitors (SGLT2i) in Cardiac Amyloidosis: A Systematic Review: Study protocol

##plugins.themes.academic_pro.article.main##

Rim Bourguiba
Saoussen Antit
Sarra Ben Rejeb
Syrine Bellakhal
Lilia Zakhama

Abstract

Background: Sodium-glucose transport protein 2 inhibitors (SGLT2i) have revolutionized the management of heart failure and renal dysfunction. Cardiac amyloidosis, an underdiagnosed cause of heart failure, primarily results from light-chain (AL) or transthyretin (ATTR) deposition. Emerging evidence suggests that SGLT2i may improve cardiac and renal outcomes in these patients. However, data on their efficacy and safety in cardiac amyloidosis remain limited. This study aimed to conduct a systematic review to evaluate the efficacy and safety of SGLT2i in cardiac amyloidosis.


Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered on PROSPERO (CRD42024584183). A comprehensive search was performed across PubMed, Embase, Google Scholar, ScienceDirect, and Cochrane Library databases, including studies involving adult patients with AL or ATTR cardiac amyloidosis. Outcomes analyzed included cardiovascular mortality, heart failure hospitalizations, New York Heart Association (NYHA) functional class, left ventricular ejection fraction (LVEF), NT-proBNP, renal parameters, and adverse events. Data were synthesized using a random-effects model to account for heterogeneity, with effect measures expressed as risk ratios (RR) or mean differences (MD) and 95% confidence intervals (CIs).


Results: Preliminary findings indicate that SGLT2i use in cardiac amyloidosis is associated with significant improvements in LVEF, NT-pro BNP levels, and renal parameters such as eGFR and albuminuria progression. A reduction in heart failure hospitalizations and stabilization of NYHA functional class were also observed. Adverse events, including genitourinary infections and orthostatic hypotension, were reported but were consistent with known SGLT2i safety profiles. However, heterogeneity in study designs and small sample  ..(abstract truncated at 250 words).

Keywords:

cardiac amyloidosis Sodium, glucose transport protein 2 inhibitors

##plugins.themes.academic_pro.article.details##

References

  1. Bloom MW, Gorevic PD. Cardiac Amyloidosis. Ann Intern Med 2023; 176: ITC33–ITC48.
  2. Van Der Aart-van Der Beek AB, De Boer RA, Heerspink HJL. Kidney and heart failure outcomes associated with SGLT2 inhibitor use. Nat Rev Nephrol 2022; 18: 294–306.
  3. Lang FM, Teruya S, Cuomo M, et al. Safety and Efficacy of SGLT2 Inhibitors for Amyloid Light-Chain Cardiomyopathy. Journal of Cardiac Failure 2024; 30: 1641–1646.
  4. Steinhardt MJ, Cejka V, Chen M, et al. Safety and Tolerability of SGLT2 Inhibitors in Cardiac Amyloidosis—A Clinical Feasibility Study. JCM 2024; 13: 283.
  5. Dobner S, Bernhard B, Asatryan B, et al. SGLT2 inhibitor therapy for transthyretin amyloid cardiomyopathy: early tolerance and clinical response to dapagliflozin. ESC Heart Failure 2023; 10: 397–404.
  6. Porcari A, Cappelli F, Nitsche C, et al. SGLT2 Inhibitor Therapy in Patients With Transthyretin Amyloid Cardiomyopathy. Journal of the American College of Cardiology 2024; 83: 2411–2422.
  7. Lang FM, Teruya S, Weinsaft A, et al. Sodium–glucose cotransporter 2 inhibitors for transthyretin amyloid cardiomyopathy: Analyses of short‐term efficacy and safety. European J of Heart Fail 2024; 26: 938–947.
  8. Pillai A, Riaz S, Arora S, et al. The Role of Sodium-Glucose Cotransporter-2 Inhibitors in Adults With Transthyretin Cardiac Amyloidosis: A Single-Center Retrospective Cohort Study. Cureus. Epub ahead of print 30 October 2024. DOI: 10.7759/cureus.72725.
  9. Sivamurugan A, Byer SH, Grewal US, et al. Impact of SGLT2 inhibitors on the outcomes of patients with cardiac arrhythmias and transthyretin cardiac amyloidosis. Heart Rhythm 2024; S1547527124032922.
  10. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021; n71.