Effect of SGLT2 inhibitors on cardiac structure and function assessed by CMR: a systematic review and meta-analysis

Presenting Author(s)

• IL

  Isabella Leo, MD, PhD

  Consultant Cardiologist
  Magna Graecia University
  Crotone, Calabria, Italy

Primary Author(s)

• IL

  Isabella Leo, MD, PhD

  Consultant Cardiologist
  Magna Graecia University
  Crotone, Calabria, Italy

Co-Author(s)

• NS

  Nadia Salerno, MD, PhD

  Consultant Cardiologist
  Magna Graecia University, Italy
• 

  Stefano Figliozzi, MD

  Cardiologist
  Humanitas Research Institute
  Alatri, Lazio, Italy
• AC

  Angelica Cersosimo, MD

  PhD Candidate
  Magna Graecia University
  Crotone, Italy
• JI

  Jessica Ielapi, MD

  PhD Candidate
  Magna Graecia University, Italy
• 

  Santo Dellegrottaglie, MD, PhD

  Director, Advanced Cardiovascular Imaging Unit
  Villa dei Fiori Hospital Acerra, Naples, Italy
  Caserta, Campania, Italy
• SS

  Sabato Sorrentino, MD, PhD

  Associate Professor
  Magna Graecia University, Italy
• GB

  Giandomenico Bisaccia, MD, PhD, MSc

  CMR Fellow
  Royal Brompton and Harefield Hospitals
  CHIETI, Abruzzi, Italy
• SD

  Salvatore De Rosa, MD, PhD

  Full Professor
  Magna Graecia University, Italy
• KS

  Kamil Stankowski, MD

  Cardiology Resident
  Humanitas Research Institute, Italy
• 

  Chiara Bucciarelli-Ducci, MD, PhD

  Consultant cardiologist
  Royal Brompton & Harefield NHS Foundation Trust
  London , England, United Kingdom
• DT

  Daniele Torella, MD, PhD

  Full Professor
  Magna Graecia University, Italy

Background: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve outcomes in patients with heart failure (HF) but underlying mechanisms remain incompletely understood. Cardiac magnetic resonance (CMR) is key in evaluating cardiac structure and function, enabling accurate assessment of reverse remodeling. Aim of this systematic review and meta-analysis was to assess the effects of SGLT2i on cardiac remodeling evaluated by CMR changes.

Methods: We conducted a systematic review and meta-analysis of studies assessing changes in CMR parameters in patients treated with SGLT2i (PROSPERO registration: CRD42024574302). Databases were searched through April 30, 2025. Random-effects models were used to pool mean changes in left and right ventricular volumes, mass, function, stroke volume, global longitudinal strain, left atrial volume, and tissue characterization indices. Meta-regression and sensitivity analyses were performed to evaluate potential sources of heterogeneity.

Results: Twenty-three studies and 1008 patients were included. Treatment with SGLT2i was associated with significant reductions in left ventricular (LV) end-diastolic volume (− 7.10 mL; 95% CI: −13.01 to − 1.19, p = 0.023), left ventricular mass (− 4.24 g; 95% CI: −7.88 to − 0.60, p = 0.027) and epicardial adipose tissue (-4.94 ml; 95% CI: -9.06, -0.82, p = 0.019). A subgroup analysis in patients with reduced LV ejection fraction showed improvement in LV stroke volume. Meta-regression revealed no significant effect of age, male sex or diabetes prevalence on pooled estimates.

Conclusion: This meta-analysis demonstrated an association between SGLT2i treatment and reductions in both LVEDV and LVM. However, these effects were not confirmed in the sub-group analysis limited to patients with heart failure, while a significant reduction in LVM was observed among patients with diabetes. The heterogeneity of the study populations included in the meta-analysis limits the generalizability of the results; Nonetheless, they support the mechanistic hypothesis that reverse left ventricular remodeling may contribute to the cardiovascular benefits observed with SGLT2i therapy.

Figure 1. Forest plots: meta-analyses on LVEDV (A), LVESV (B), LVEDVi (C) and LVESVi (D).
Figure 2. Forest plots: meta-analyses on LAVi (A), LVEF (B), LVM (C) and LVMi (D).