AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Reverse Remodeling with SGLT2 Inhibition on Cardiac MRI in Heart Failure A Meta Analysis of Randomized Trials
By Alajmi H, Sherwani MRK, Arobo A et al.
Background: Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve outcomes in heart failure (HF), yet their structural effects on the myocardium remain incompletely defined. Cardiac MRI (CMR) provides precise quantification of ventricular volumes and mass, enabling differentiation between true reverse remodeling and loading effects. Methods: We systematically searched PubMed, EMBASE, and Cochrane for randomized controlled trials comparing SGLT2 inhibitors with placebo in HF patients undergoing serial CMR. Eligible studies reported changes in ventricular structure or function. Outcomes included LVEF, LV end-systolic volume (LVESV), LV end-diastolic volume (LVEDV), LV mass (LVM), their indexed measures (LVESVi, LVEDVi, LVMi), and left atrial volume index (LAVi). Mean changes from baseline were pooled using random-effects models (DerSimonian-Laird). Results: Ten RCTs (n = 868) were included. SGLT2 inhibitors significantly improved LVEF (MD +1.90; 95% CI 0.63 to 3.17; P = 0.003) and reduced LVESV (MD –6.41 mL; 95% CI –12.11 to –0.71; P = 0.03) and LVM (MD –6.34 g; 95% CI –10.21 to –2.47; P = 0.001). No significant differences were observed in LVEDV (MD +0.85 mL; P = 0.83), LVEDVi, LVESVi, LVMi, or LAVi. Heterogeneity was low to moderate, and results remained consistent on sensitivity analyses. Conclusions: SGLT2 inhibition is associated with modest but significant reverse remodeling on CMR, characterized by improved systolic function and reduced LV mass. The discordance between absolute and indexed parameters suggests contributions from both intrinsic myocardial effects and loading conditions. Further studies incorporating T1 mapping and extracellular volume are needed to define antifibrotic mechanisms.