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Early use of sodium-glucose cotransporter 2 inhibitors (SGLT-2) therapy can be recommended for improving left ventricular ejection fraction in case of heart failure.
A recent study by Jia Tang et al. has highlighted the efficacy of adding SGLT-2 to the combination therapy of angiotensin receptor neprilysin inhibitors (ARNI), beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA) for cardiac remodelling reversal.
This new quadruple regimen, ARNI + BB + MRA + SGLT-2i, was demonstrated to be superior over the traditional "golden triangle" therapy of Angiotensin-converting enzyme (ACE) inhibitors (ACEI) + BB + MRA in improving left ventricular ejection fraction (LVEF) and associated symptoms.
The ‘Chinese Medical Journal’ featured this study that explored the effectiveness of SGLT-2, ARNI, BB, MRA, ACEIs and ARBs for treating heart failure with reduced ejection fraction (HFrEF). The PubMed, Embase and Cochrane Library databases were searched for relevant randomized trials. Sixty RCTs with 16,425 patients were counted.
Study results in comparison with placebo:
Adding SGLT-2i to ARNI/ACEI + BB + MRA reverses cardiac remodelling effectively and the quadruple therapy "ARNI + BB + MRA + SGLT-2i" surpasses the "golden triangle" in enhancing LVEF, as concluded.
Chinese Medical Journal
Pharmacotherapy in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis
Jia Tang et al.
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