Eficácia dos ISGLT2 na insuficiência cardíaca com fração de ejeção reduzida (ICFEr)

Abstract

INTRODUCTION: Heart failure is a clinical syndrome with high prevalence and global impact, associated with high morbidity, mortality, and healthcare costs, whose incidence increases with population aging and greater survival after acute cardiovascular events. In this scenario, sodium-glucose cotransporter 2 inhibitors have emerged as an innovative pharmacological class, initially developed for diabetes mellitus, but which has demonstrated cardiovascular and renal benefits independent of glycemic control. OBJECTIVES: To analyze the efficacy of SGLT2 inhibitors in heart failure with preserved ejection fraction (HFpEF). METHODOLOGY: This is a literature review conducted between January and February 2026, with searches in the PubMed and SciELO databases using descriptors related to heart failure and SGLT2 inhibitors. Articles published between 2013 and 2026, in Portuguese, English, Spanish, and French, of the review or meta-analysis type, available in full, were included. Duplicate studies, studies in abstract format, or studies not aligned with the research objective were excluded. Of the 1,555 articles initially identified, 10 studies from PubMed met the criteria and comprised the final sample. DISCUSSION: The study demonstrates that, in patients with heart failure with reduced and intermediate ejection fraction, SGLT2 inhibitors do not promote improvement independent of left atrial structure or function after multivariate adjustments. The initial differences observed mainly reflect greater clinical severity and indication bias in the treated group. The potential atrial effects described experimentally appear to be outweighed by advanced ventricular dysfunction and comorbidity burden. Thus, the benefits of SGLT2 inhibitors are predominantly expressed in major clinical outcomes, and not in isolated atrial remodeling. CONCLUSION: This conclusion reinforces that SGLT2 inhibitors represent a fundamental and safe therapeutic option in the contemporary management of heart failure, although specific prospective studies with long-term follow-up are still needed to fully clarify their structural impacts and optimize their application in subgroups of patients with preserved ejection fraction.