Dapagliflozin pada Gagal Jantung dengan Fraksi Ejeksi Rendah (HFrEF): Tinjauan Sistematis Mekanisme dan Efektivitas Klinis
Statistik artikel
Data OJS dan sumber sitasiTayangan dan unduhan adalah aktivitas yang tercatat di OJS; pemrosesan statistik dapat tertunda. Tanda — berarti angka dari sumber tersebut belum tersedia. Cari di Google Scholar
Isi Artikel Utama
Abstrak
Latar Belakang: Gagal jantung dengan fraksi ejeksi rendah (HFrEF) merupakan kondisi serius dengan morbiditas dan mortalitas tinggi. Dapagliflozin menunjukkan efek kardioprotektif pada pasien HFrEF. Tujuan: Tinjauan ini mengeksplorasi mekanisme yang mendasari manfaat klinis dapagliflozin dan merangkum bukti terkini dari DAPA-HF serta sub-analisisnya mengenai efektivitasnya pada pasien dengan HFrEF. Metode: Literatur dicari secara sistematis di PubMed, Google Scholar, dan Scopus. Data dari studi yang memenuhi kriteria dianalisis secara naratif untuk merangkum mekanisme aksi dan outcome klinis. Hasil: Dapagliflozin meningkatkan efisiensi energi jantung, merangsang eritropoiesis, mengurangi fibrosis miokard, dan menurunkan stres oksidatif serta NT-proBNP. Secara klinis, terapi 10 mg/hari mengurangi rawat inap akibat gagal jantung dan kematian kardiovaskular dengan penurunan risiko relatif 26% (HR: 0.74), sementara pasien yang baru dirawat menunjukkan manfaat hingga 49% (HR: 0.51), konsisten di berbagai subpopulasi dan menambah keuntungan dari terapi standar. Kesimpulan: Dapagliflozin merupakan terapi tambahan efektif untuk HFrEF, memberikan manfaat cepat dan berkelanjutan, menurunkan morbiditas dan mortalitas, serta meningkatkan kualitas hidup pasien. Penelitian lebih lanjut diperlukan untuk memperluas penerapan klinis.
Rincian Artikel
Terbitan
Bagian

Artikel ini berlisensiCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Cara Mengutip
Referensi
Corneanu LE, Sîngeap MS, Mutruc V, Petriș OR, Toma TP, Șorodoc V, et al. The Complex Relationship Between Heart Failure and Chronic Obstructive Pulmonary Disease: A Comprehensive Review. J Clin Med 2025;14:4774. https://doi.org/10.3390/jcm14134774.
Shang Z, Wang X, Gao W. Heart failure with mildly reduced ejection fraction: Emerging frontiers in clinical characteristics, prognosis, and treatment. Rev Cardiovasc Med 2022;23. https://doi.org/10.31083/j.rcm2301030.
Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res 2022;118:3272–87. https://doi.org/10.1093/cvr/cvac013.
Kerr B, Pharithi RB, Barrett M, Halley C, Gallagher J, Ledwidge M, et al. Angiotensin Receptor Neprilysin Inhibitors in HFrEF: Is This the First Disease Modifying Therapy Drug Class Leading to a Substantial Reduction in Diuretic Need? International Journal of Heart Failure 2021;3:106–16. https://doi.org/10.36628/ijhf.2020.0043.
Wirtz HS, Sheer R, Honarpour N, Casebeer AW, Simmons JD, Kurtz CE, et al. Real-world analysis of guideline-based therapy after hospitalization for heart failure. J Am Heart Assoc 2020;9. https://doi.org/10.1161/JAHA.119.015042.
Maddox TM, Januzzi JL, Allen LA, Breathett K, Brouse S, Butler J, et al. 2024 ACC Expert Consensus Decision Pathway for Treatment of Heart Failure With Reduced Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2024;83:1444–88. https://doi.org/10.1016/j.jacc.2023.12.024.
McMurray JJ V, DeMets DL, Inzucchi SE, Køber L, Kosiborod MN, Langkilde AM, et al. The Dapagliflozin And Prevention of Adverse-outcomes in Heart Failure (DAPA-HF) trial: baseline characteristics. Eur J Heart Fail 2019;21:1402–11. https://doi.org/10.1002/ejhf.1548.
Selvaraj S, Fu Z, Jones P, Kwee LC, Windsor SL, Ilkayeva O, et al. Metabolomic Profiling of the Effects of Dapagliflozin in Heart Failure With Reduced Ejection Fraction: DEFINE-HF. Circulation 2022;146:808–18. https://doi.org/10.1161/CIRCULATIONAHA.122.060402.
Aberle J, Menzen M, Schmid SM, Terkamp C, Jaeckel E, Rohwedder K, et al. Dapagliflozin effects on haematocrit, red blood cell count and reticulocytes in insulin-treated patients with type 2 diabetes. Sci Rep 2020;10. https://doi.org/10.1038/s41598-020-78734-z.
Ortega-Paz L, Laudani C, Sionis A, Vidal-Cales P, Arevalos V, Andrea R, et al. Effect of DAPAgliflozin on Myocardial Fibrosis and Ventricular Function in Patients with ST-Segment Elevation Myocardial Infarction—DAPA-STEMI Trial. J Cardiovasc Dev Dis 2025;12. https://doi.org/10.3390/jcdd12060220.
Butt JH, Docherty KF, Petrie MC, Schou M, Kosiborod MN, O’Meara E, et al. Efficacy and Safety of Dapagliflozin in Men and Women with Heart Failure with Reduced Ejection Fraction: A Prespecified Analysis of the Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure Trial. JAMA Cardiol 2021;6:678–89. https://doi.org/10.1001/jamacardio.2021.0379.
Petrie MC, Verma S, Docherty KF, Inzucchi SE, Anand I, Bělohlávek J, et al. Effect of Dapagliflozin on Worsening Heart Failure and Cardiovascular Death in Patients with Heart Failure with and Without Diabetes. JAMA - Journal of the American Medical Association 2020;323:1353–68. https://doi.org/10.1001/jama.2020.1906.
Jhund PS, Ponikowski P, Docherty KF, Gasparyan SB, Böhm M, Chiang CE, et al. Dapagliflozin and Recurrent Heart Failure Hospitalizations in Heart Failure with Reduced Ejection Fraction: An Analysis of DAPA-HF. Circulation 2021;143:1962–72. https://doi.org/10.1161/CIRCULATIONAHA.121.053659.
Butt JH, Nicolau JC, Verma S, Docherty KF, Petrie MC, Inzucchi SE, et al. Efficacy and safety of dapagliflozin according to aetiology in heart failure with reduced ejection fraction: insights from the DAPA-HF trial. Eur J Heart Fail 2021;23:601–13. https://doi.org/10.1002/ejhf.2124.
Butt JH, Docherty KF, Jhund PS, de Boer RA, Böhm M, Desai AS, et al. Dapagliflozin and atrial fibrillation in heart failure with reduced ejection fraction: insights from DAPA-HF. Eur J Heart Fail 2022;24:513–25. https://doi.org/10.1002/ejhf.2381.
Berg DD, Jhund PS, Docherty KF, Murphy SA, Verma S, Inzucchi SE, et al. Time to Clinical Benefit of Dapagliflozin and Significance of Prior Heart Failure Hospitalization in Patients with Heart Failure with Reduced Ejection Fraction. JAMA Cardiol 2021;6:499–507. https://doi.org/10.1001/jamacardio.2020.7585.
Dewan P, Docherty KF, Bengtsson O, de Boer RA, Desai AS, Drozdz J, et al. Effects of dapagliflozin in heart failure with reduced ejection fraction and chronic obstructive pulmonary disease: an analysis of DAPA-HF. Eur J Heart Fail 2021;23:632–43. https://doi.org/10.1002/ejhf.2083.
Jhund PS, Solomon SD, Docherty KF, Heerspink HJL, Anand IS, Böhm M, et al. Efficacy of Dapagliflozin on Renal Function and Outcomes in Patients with Heart Failure with Reduced Ejection Fraction: Results of DAPA-HF. Circulation 2021;143:298–309. https://doi.org/10.1161/CIRCULATIONAHA.120.050391.
Solomon SD, Jhund PS, Claggett BL, Dewan P, Køber L, Kosiborod MN, et al. Effect of Dapagliflozin in Patients With HFrEF Treated With Sacubitril/Valsartan: The DAPA-HF Trial. JACC Heart Fail 2020;8:811–8. https://doi.org/10.1016/j.jchf.2020.04.008.
Ansar F, Azzam A, Zafar U, Ahmed S, Ghauri FK, Khan AM, et al. Empagliflozin and Cardiovascular Outcomes: A Systematic Review of Randomized Controlled Trials in Populations With Diabetes and Heart Failure. Cureus 2025. https://doi.org/10.7759/cureus.90150.
Docherty KF, McMurray JJV. SOLOIST-WHF and updated meta-analysis: sodium–glucose co-transporter 2 inhibitors should be initiated in patients hospitalized with worsening heart failure. Eur J Heart Fail 2021;23:27–30. https://doi.org/10.1002/ejhf.2075.





