Abstract Body (Do not enter title and authors here):
Background: Sodium-glucose cotransporter 2 inhibitor has shown its cardio-renal protective effects in previous clinical studies. However, its effect on cardiac amyloidosis patients is still controversial, with limited studies to date.
Objective: We sought to evaluate the efficacy of SGLT2i in patients with transthyretin amyloid cardiomyopathy (ATTR-CM).
Methods: We performed a systematic literature search on an electronic database for relevant randomized controlled trials (RCTs) and cohort studies from inspection until June 4th, 2025. Studies were considered to be eligible for inclusion if patients were ≥18 years of age and had ATTR-CM or cardiac amyloidosis as the diagnosis. Our intervention group was with patients on SGLT2i and a control group of no SGLT2i, along with outcomes of interest. Odds ratios (OR) and 95% confidence intervals (CI) were pooled using a random-effect model, and a p-value of <0.05 was considered statistically significant.
Results
The initial search strategy yielded 1760 articles of which 98 duplicates were removed, and 1605 articles were excluded after the title and abstract screening.
Finally, a total of 5 studies with 5,095 patients (2,505 in the SGLT2i group and 2,590 in the control group) were included in the analysis. The mean age of patients in SGLT2i and control groups was 65.3 and 65.2 years. The mean follow-up duration was 2.1 years. Pooled analysis showed that the SGLT2i group of patients were having a significantly lower risk of all cause mortality (OR, 0.46 (95%CI: 0.36-0.60), p<0.001, I2=23.23%), cardiovascular mortality (OR, 0.29(95%CI: 0.16-0.51), p<0.001, I2=7.90%) when compared with control groups. However, the risk of heart failure hospitalization (OR, 0.65(95%CI: 0.33-1.29), p=0.22, I2=7.90%) was comparable between both groups of patients.
Conclusion: The administration of SGLT2i in ATTR-CM Patients significantly reduced the risk of all-cause mortality and cardiovascular mortality compared with non non-SGLT2i group of patients.