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Background <p>Residual mortality and heart-failure events remain common after aortic valve intervention for severe aortic stenosis. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes in heart-failure, diabetes, and chronic kidney disease populations, but their role following transcatheter or surgical aortic valve intervention remains uncertain.</p> Methods <p>PubMed, Scopus, ScienceDirect, Cochrane Library, citation tracking, and manually identified eligible studies were screened through June 2026 for randomized and observational studies comparing SGLT2i with usual care or no SGLT2i after aortic valve intervention. The review was registered in PROSPERO (CRD420251059332). Eligible populations included TAVR, SAVR, and bioprosthetic aortic valve evidence where available. Adjusted hazard ratios (HRs) were pooled using random-effects models while non-HR estimates and non-comparable endpoints were summarized narratively.</p> Results <p>Twelve eligible reports were included, comprising one randomized trial and 11 observational studies. Most time-to-event estimates were reported from TAVR cohorts; two SAVR-only studies and one mixed bioprosthetic AVR study added complementary surgical and valve-durability data. In the pooled time-to-event analysis, SGLT2i use was associated with lower all-cause mortality (HR 0.69, 95% CI 0.60–0.79; I²=5%; <i>p</i> &lt; 0.001). The study-defined composite clinical outcome was also lower (HR 0.68, 95% CI 0.53–0.89; I²=57%; <i>p</i> = 0.005), although component definitions differed across studies. Estimates for heart-failure hospitalization or exacerbation, atrial fibrillation, and acute kidney injury were not statistically significant.</p> Conclusions <p>SGLT2i use after aortic valve intervention was associated with lower all-cause mortality in pooled time-to-event analysis. SAVR data were clinically informative but were not sufficiently homogeneous for separate quantitative pooling. Findings for composite, heart-failure, rhythm, renal, and valve-related outcomes remain less certain. Dedicated randomized trials are needed to confirm whether the observed association reflects a treatment effect and to define patient selection, treatment timing, and peri-procedural safety.</p> Graphical abstract <p></p>

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SGLT2 inhibitor therapy following aortic valve intervention for aortic stenosis: a systematic review and meta-analysis of mortality, heart failure, rhythm, renal, and valve-related outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月28日

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  • Hamzah Pratama Megantara,
  • Iwan Dakota,
  • Taofan Taofan,
  • Suci Indrian,
  • Ruth Grace Aurora,
  • Suko Adiarto

摘要

Background

Residual mortality and heart-failure events remain common after aortic valve intervention for severe aortic stenosis. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) improve cardiovascular and renal outcomes in heart-failure, diabetes, and chronic kidney disease populations, but their role following transcatheter or surgical aortic valve intervention remains uncertain.

Methods

PubMed, Scopus, ScienceDirect, Cochrane Library, citation tracking, and manually identified eligible studies were screened through June 2026 for randomized and observational studies comparing SGLT2i with usual care or no SGLT2i after aortic valve intervention. The review was registered in PROSPERO (CRD420251059332). Eligible populations included TAVR, SAVR, and bioprosthetic aortic valve evidence where available. Adjusted hazard ratios (HRs) were pooled using random-effects models while non-HR estimates and non-comparable endpoints were summarized narratively.

Results

Twelve eligible reports were included, comprising one randomized trial and 11 observational studies. Most time-to-event estimates were reported from TAVR cohorts; two SAVR-only studies and one mixed bioprosthetic AVR study added complementary surgical and valve-durability data. In the pooled time-to-event analysis, SGLT2i use was associated with lower all-cause mortality (HR 0.69, 95% CI 0.60–0.79; I²=5%; p < 0.001). The study-defined composite clinical outcome was also lower (HR 0.68, 95% CI 0.53–0.89; I²=57%; p = 0.005), although component definitions differed across studies. Estimates for heart-failure hospitalization or exacerbation, atrial fibrillation, and acute kidney injury were not statistically significant.

Conclusions

SGLT2i use after aortic valve intervention was associated with lower all-cause mortality in pooled time-to-event analysis. SAVR data were clinically informative but were not sufficiently homogeneous for separate quantitative pooling. Findings for composite, heart-failure, rhythm, renal, and valve-related outcomes remain less certain. Dedicated randomized trials are needed to confirm whether the observed association reflects a treatment effect and to define patient selection, treatment timing, and peri-procedural safety.

Graphical abstract