Do sodium-glucose cotransporter-2 inhibitors impact pulmonary symptoms in heart failure patients? A systematic literature review

Background: Sodium-glucose cotransporter-2 (SGLT2) inhibitors have shown promise for reducing adverse cardiovascular events in patients with heart failure. Our study looked at the effects of SGLT2 inhibitor use on pulmonary outcomes in patients with all types of heart failure. With comorbidities such as pulmonary hypertension in patients with heart failure, we looked at the evidence of pulmonary function in patients with heart failure through echocardiogram. Our study seeks to determine the use of SGLT2 inhibitors to alleviate pulmonary comorbidities in heart failure patients.

Methods: We employed a search string to identify relevant published manuscripts on Cochrane Database of Systematic Literature Reviews, PubMed, Web of Science, Scopus, and Embase. Authors screened articles by title and abstract based upon predetermined inclusion criteria in a double-blind fashion. Full text of included articles were then screened for relevant pulmonary measures and outcomes. General study characteristics, patient population measures, echocardiogram measures, pulmonary measures, and pulmonary outcomes were recorded.

Results: Our literature search returned 2,367 articles, of which 22 met inclusion criteria. Echocardiograms were performed, and various measures were recorded across all of the 22 included studies. These measures included tricuspid valve pressures in 7 studies (31.8% [7/22]), right atrium pressures in 3 studies (13.6% [3/22]), right ventricle pressures in 4 studies (18.1% [4/22]), pulmonary artery pressure in 10 studies (45.5% [10/22]), left atrium pressures in 17 studies (77.3% [17/22]), and mitral valve pressures in 14 studies (63.6% [14/22]). Pulmonary outcomes were reported in 12 articles (54.5% [12/22]). Among these, 4 studies (33.3% [4/12]) recorded pulmonary capillary wedge pressure, 3 studies (25.0% [3/12]) performed a cardiopulmonary exercise test, 5 studies (41.7% [5/12]) performed a 6-minute walk test, 2 studies (16.7% [2/12]) performed a lung ultrasound, and 1 study (8.3% [1/12]) obtained a clinical dyspnea score.

Conclusion: Out of the 22 articles included in our study, none explicitly looked at the impact of pulmonary outcomes in heart failure patients while taking a SGLT2 inhibitor. While some studies report pulmonary outcome measures with SGLT2 usage in heart failure patients, there is a lack of standardization and consistency of these measures, as none of the included studies used the same measures. While methods to assess pulmonary function are available, they are often used inconsistently or not fully reported, hindering the ability to evaluate the effects of SGLT2 inhibitors on pulmonary outcomes and comorbidities in heart failure patients. In order to gain insight on the impact of SGLT2 inhibitors on pulmonary symptoms in heart failure patients, standardization of these measures is essential to better understand pulmonary outcomes and comorbidities in these patients.