Sglt2 Inhibitors And The Clinical Conundrum Of Heart Failure With Preserved Ejection Fraction

Abstract

The terminology, Heart Failure with Preserved Ejection Fraction (HFpEF) denotes a specific subset of a wider spectrum of cardiac failure. Neurohormonal blockade using Angiotensin converting enzyme inhibitors, Angiotensin receptor blockers, Angiotensin receptor neprilysin inhibitors, Mineralocorticoid receptor antagonists and beta blockers have been the mainstay of the treatment of heart failure thus far. However, the Sodium Glucose cotransporter inhibitors (SGLT2i) have recently found favor with the cardiologists for their pleiotropic effects on the heart leading to considerable prognostic benefits in heart failure patients. Initial studies have convincingly demonstrated the benefit of these drugs in heart failure with reduced ejection fraction (HFrEF). But the benefit of SGLT2i in HFpEF is yet to be determined conclusively. This review article is a therefore a narrative on the cardiac pharmacology of the SGLT2 inhibitors and their evolving role in the management of HFpEF based on evidence from recent trials and studies.