Angiotensin converting enzyme inhibitors (ACEIs) for anthracycline-induced cardiotoxicity: a systematic review and...

Anthracyclines are widely used in cancer treatment and cause dose-dependent cardiotoxicity 2 different by increasing oxidative stress and RAS activation. Angiotensin converting enzyme inhibitors (ACEIs) show promise in reducing this damage.

This systematic review and meta-analysis evaluated the efficacy and safety of ACEIs in preserving left ventricular function and reducing cardiotoxicity associated with anthracycline therapy.

A comprehensive search of databases up to May 2024 included randomized controlled trials (RCTs) that assessed ACEIs to prevent cardiotoxicity. Random-effects meta-analysis was applied.

The primary outcome was changes in left ventricular ejection fraction (LVEF). Secondary outcomes included cardiac event incidence and adverse events.

Nine RCTs were included, encompassing 869 patients (440 ACEI group, 429 control group).

ACEIs significantly improved LVEF at six months (mean difference of 7.93%; 95% CI 3.18-12.67%; P=.001) but not at 12 months. Moreover, ACEIs were associated with non-statistically significant lower rates of heart failure and arrhythmia development compared to the control, with no significant differences noted in adverse events.

Evidence quality was high for short-term LVEF improvement and moderate-to-low for other outcomes. Egger's regression test indicated a low risk of publication bias for LVEF.

High (I²=97%) for LVEF at 6 months.

ACEIs prevent cardiotoxicity in the short term without increasing adverse events. More extensive trials are needed to confirm long-term benefits.

The small number of RCTs and high heterogeneity limit the study. Inconsistent reporting of baseline cardiovascular factors and confounders also hindered accurate assessment of treatment effects.

PROSPERO CRD42024555546.