The effect of empagliflozin on cardiac function and structure in patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis

Introduction:
Empagliflozin was shown to improve the clinical outcomes of cardiovascular diseases; however, its effects on cardiac structure and cardiac remodeling in patients with heart failure remain controversial to some extent.

Aim:
We conducted this meta-analysis to compare the effect of empagliflozin with placebo on cardiac structure and function among patients with heart failure.

Methods:
PubMed, Scopus, Web of Science, and the Cochrane Library were systematically searched from inception to December 20, 2024, to identify randomized controlled trials comparing the effects of empagliflozin with placebo on cardiac structure and function in patients with heart failure. A random-effects model (DerSimonian-Laird) was employed to pool data.

Results:
Four studies with 234 individuals in the empagliflozin group and 231 individuals in the placebo group were included. Compared to placebo, empagliflozin 10 (mg/day) significantly increased left ventricular ejection fraction (LVEF) (WMD 2.96%, 95% CI (0.84, 5.09), I² = 85.28%), decreased left ventricular (LV) end-diastolic volume (WMD –17.05 ml, 95% CI (–23.68, –10.42), I² = 13.88%), LV end-diastolic volume index (WMD –7.59 ml/m², 95% CI (–10.08, –5.10), I² = 0.00%), LV end-systolic volume (WMD –15.59 ml, 95% CI (–25.89, –5.28), I² = 74.69%), LV end-systolic volume index (WMD –6.68 ml/m², 95% CI (–7.95, –5.41), I² = 0.00%), and left atrial volume index (WMD –2.16 ml/m², 95% CI (–4.21, –0.10), I² = 0.00%), but did not significantly change LV mass (WMD –11.66 g, 95% CI (–30.54, 7.22), I² = 90.02%) and LV mass index (WMD –4.01 g/m², 95% CI (–10.94, 2.92), I² = 64.29%).

Conclusions:
Empagliflozin can significantly improve myocardial function and prevent myocardial remodeling in patients with heart failure.