The Impact of SGLT2 Inhibitors on Pulmonary Artery Pressures and Pulmonary Hemodynamics in Patients With Heart Failure: A Systematic Review
Bibliographic record
Abstract
Background Heart failure is a major global health burden associated with high morbidity and mortality. Elevated pulmonary artery pressures (PAP) are linked to worse outcomes in heart failure patients. Sodium–glucose cotransporter 2 (SGLT2) inhibitors, initially developed for diabetes, have demonstrated cardiovascular benefits, but their specific effects on pulmonary hemodynamics remain unclear. Methods This systematic review analyzed randomized controlled trials and observational cohort studies evaluating the effects of SGLT2 inhibitors on mean pulmonary artery pressure (mPAP) and pulmonary artery systolic pressure (PASP) in heart failure patients. A comprehensive search of PubMed, Embase, Cochrane Library, and Scopus databases was conducted until August 2024. Studies were appraised using PRISMA and AMSTAR guidelines, the Cochrane bias tool, and the Newcastle–Ottawa Scale. Hypothesis SGLT2 inhibitors reduce PAPs in heart failure patients, leading to beneficial pulmonary hemodynamic effects. Results Six studies (four RCTs and two observational; n = 346) were included. At rest, pooled analysis of three trials showed a significant reduction in mPAP (MD −1.41 mmHg; 95% CI −2.80 to −0.01; p = 0.05; I 2 = 12 % ). During exercise, two studies demonstrated a nonsignificant reduction in mPAP (MD −3.12 mmHg; 95% CI −7.60 to 1.36; p = 0.17; I 2 = 54 % ). For PASP, pooled analysis of four studies suggested a nonsignificant reduction (MD −6.72 mmHg; 95% CI −14.98 to 1.54; p = 0.11; I 2 = 96 % ), but sensitivity analysis excluding one outlier yielded a significant effect (MD −2.76 mmHg; 95% CI −4.99 to −0.53; p = 0.02; I 2 = 0 % ). Secondary outcomes included significant reductions in PCWP, PADP, and NT‐proBNP. Conclusion SGLT2 inhibitors demonstrate beneficial effects on pulmonary pressures and hemodynamics in patients with heart failure, with consistent trends toward lower mPAP, PASP, and PCWP. Although results are influenced by study heterogeneity, the overall evidence suggests meaningful hemodynamic improvements. Larger, long‐term randomized trials are warranted to clarify subgroup effects (HFrEF vs. HFpEF and dapagliflozin vs. empagliflozin) and establish clinical implications.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.004 | 0.002 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".