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Protective Effects of ACEI/ARB on Left Ventricular Function in Anthracycline-Induced Chronic Cardiotoxicity: A

Hong Lin1,2, Guoxi Liang1,2, Yanxuan Wu2,3

  • 1Department of Oncology, The First Affiliated Hospital of Shantou University Medical College, Shantou, China.

Cardiology
|May 4, 2021
PubMed
Abstract

Insights

Prophylactic use of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) can help preserve left ventricle ejection fraction (LVEF) in patients receiving anthracyclines. These drugs show potential benefits against anthracycline-induced cardiotoxicity without significantly increasing hypotension.

Area of Science:

  • Cardiology
  • Oncology
  • Pharmacology

Background:

  • Anthracyclines are potent chemotherapy agents with a significant risk of cardiotoxicity.
  • Existing cardioprotective strategies for anthracycline therapy remain inconclusive.
  • The role of angiotensin-converting enzyme inhibitors (ACEI) and angiotensin-receptor blockers (ARB) in preventing cardiotoxicity is under investigation.

Approach:

  • A meta-analysis was conducted on 7 randomized controlled trials (RCTs).
  • The studies investigated the prophylactic use of ACEI/ARB to prevent anthracycline-induced cardiotoxicity.
  • Key endpoints included changes in left ventricle ejection fraction (LVEF), early and late diastolic peak velocity ratio (E/A), and hypotensive events.

Key Points:

  • Prophylactic ACEI/ARB use demonstrated a significant benefit in preserving LVEF (WMD -3.16%, p = 0.02).
  • No significant benefit was observed for the E/A ratio (p = 0.58).
  • The incidence of hypotensive events did not significantly increase with ACEI/ARB use (p = 0.23).

Conclusions:

  • Prophylactic ACEI/ARB therapy shows promise in reducing clinical and subclinical cardiotoxicity associated with anthracyclines.
  • The observed benefits in LVEF preservation suggest a cardioprotective role for these agents.
  • Further large-scale studies are warranted to confirm these findings due to the limited number of current trials.
Keywords:
Angiotensin-converting enzyme inhibitorsAngiotensin-receptor antagonistsAnthracyclinesCardiotoxicityMeta-analysis

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