Sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists improve indices of atrial cardiomyopathy: a systematic review and meta-analysis

Atrial cardiomyopathy has been associated with adverse outcomes.

To examine the effects of sodium-glucose cotransporter inhibitors (SGLT2i) and/or glucagon-like peptide-1 receptor agonists (GLP1RA) on indices of atrial cardiomyopathy.

MEDLINE (Pubmed), Scopus and Cochrane were searched up to October 29, 2024 for studies reporting the effects of SGLT2i/GLP1RA on atrial cardiomyopathy indices after a minimum follow-up of 3 months. Study selection, data extraction and study quality assessments were performed in a double-independent manner. Random-effects frequentist models were used to calculate mean differences (MD) and 95% confidence intervals (CI).

Totally, 36 studies (3390 participants) were included. Compared to baseline (without control), SGLT2i improved left atrial (LA) conduit strain (MD=1.23%, 95% CI [0.27, 2.18], I2=83%), LA reservoir strain (MD=3%, 95%CI [1.40, 4.61], I2=90%), LA contraction strain (MD=1.58%, 95% CI [0.40, 2.75], I2=89%), LA diameter (MD=-1.19 mm, 95% CI [-1.19, -0.42], I2=52%), septal atrial electromechanical coupling time (AECt) (MD=-5.14 ms, 95% CI [-9.87, -0.40], I2=96%), lateral AECt (MD=-7.85 ms, 95% CI [-14.96, -0.74], I2=97%), LA maximal volume (MD=-4.92 ml, 95% CI [-9.36, -0.49], I2=96%), P wave dispersion (MD=-8.03 ms, 95% CI [-10.27, -5.79], I2=60%) and P wave maximum duration (MD=-6.91 ms, 95% CI [-8.28, -5.54], I2=0%), while GLP1RA improved LA conduit strain (MD=1.8%, 95% CI [0.84, 2.76], I2=0%), LA reservoir strain (MD=3.2%, 95% CI [1.68, 4.72], I2=0%), and LA contraction strain (MD=0.90%, 95% CI [0.04, 1.76], I2=0%). Compared to control, SGLT2i improved LA volume index (MD=-3.38 ml/m2, 95% CI [-4.80, -1.96], I2=88%).

Newer oral antidiabetic drugs exert beneficial effects on electromechanical indices of atrial cardiomyopathy. Further research is required to elucidate the mechanisms outlying these actions.