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Table 2 GRADE evidence profile

From: Effect of sodium–glucose cotransporter 2 inhibitors on cardiac structure and function in type 2 diabetes mellitus patients with or without chronic heart failure: a meta-analysis

Certainty assessment

No. of patients

Effect

Certainty

Importance

No. of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

SGLT2i

Control

Relative (95% CI)

Absolute (95% CI)

LVMI

 6

Randomized trials

Not serious

Not serious

Not serious

Seriousa

None

251

254

MD 0.96 lower (2.69 lower to 0.77 higher)

Moderate

Important

LVEDVI

 3

Randomized trials

Not serious

Not serious

Not serious

Seriousa

None

89

93

MD 1.32 higher (2.20 lower to 4.85 higher)

Moderate

Important

LVESVI

 3

Randomized trials

Not serious

Not serious

Not serious

Seriousa

None

89

93

MD 0.03 lower (3.08 lower to 3.02 higher)

Moderate

Important

LAVI

 4

Randomized trials

Not serious

Not serious

Not serious

Seriousa

None

187

182

MD 0.28 lower (1.98 lower to 1.42 higher)

Moderate

Important

LVEF

 9

Randomized trials

Not serious

Not serious

Not serious

Seriousa

None

427

442

-

MD 0.21 higher (0.65 lower to 1.06 higher)

Moderate

Important

LVEF in HFrEF

 2

Randomized trials

Serious b

Not serious

Not serious

Seriousa

None

70

74

MD 3.16 higher (0.11 higher to 6.22 higher)

Low

Important

LVEF in HFpEF

 2

Randomized trials

Not serious

Not serious

Not serious

Seriousa

None

151

158

MD 0.19 higher (1.76 lower to 2.15 higher)

Moderate

Important

GLS

 4

Randomized trials

Not serious

Not serious

Not serious

Seriousa

None

162

164

MD 0.38 lower (1.04 lower to 0.29 higher)

Moderate

Important

E/eʹ

 8

Randomized trials

Not serious

Not serious

Not serious

Seriousa

None

354

371

MD 0.45 lower (0.88 lower to 0.03 lower)

Moderate

Important

NT-proBNP

 11

Randomized trials

Not serious

Not serious

Not serious

Seriousa

None

1997

1777

SMD 0.09 lower (0.16 lower to 0.03 lower)

Moderate

Critical

NT-proBNP (ln scale)

 3

Randomized trials

Not serious

Not serious

Not serious

Seriousa

None

2702

1629

SMD 0.12 lower (0.17 lower to 0.07 lower)

Moderate

Critical

KCCQ

 3

Randomized trials

Not serious

Not serious

Not serious

Not serious

None

2610

2607

SMD 3.12 higher (0.76 higher to 5.47 higher)

High

Critical

  1. SGLT2i sodium–glucose cotransporter 2 inhibitors, MD mean difference, SMD standardized mean difference, HFrEF heart failure with reduced ejection fraction, HFpEF heart failure with preserved ejection fraction, LVMI left ventricular mass indexed by body surface area, LVEDVI left ventricular end diastolic volume indexed by body surface area, LVESVI left ventricular end systolic volume indexed by body surface area, LAVI left atrial volume indexed by body surface area, LVEF left ventricular ejection fraction, GLS global longitudinal strain, E/e' mitral inflow to mitral relaxation velocity ratio, NT-proBNP N-terminal pro-brain natriuretic peptide, KCCQ the Kansas City Cardiomyopathy Questionnaire
  2. aSample size below optimal information size contributing to imprecision which lowers our certainty in effect
  3. bOne in the two studies is of high risk according to the Cochrane risk of bias tool. And excluding the study would cause change of the results