Prophylactic ACE inhibitors reduced LVEF decline by 5% (95% CI 2-8%, p<0.01) in anthracycline chemotherapy patients, with greater effect in trastuzumab regimens.
Does prophylactic ACEi prevent LVEF reduction in patients undergoing anthracycline-based chemotherapy?
Prophylactic ACE inhibitors significantly attenuate the decline in LVEF in patients receiving anthracycline-based chemotherapy, with the protective effect appearing most relevant in those also receiving trastuzumab.
Absolute Event Rate: 0% vs 0%
This study aims to evaluate the efficacy of angiotensin-converting enzyme inhibitors (ACEi) in preventing anthracycline-induced cardiotoxicity in patients undergoing anthracycline-based chemotherapy. PubMed, Embase, and Cochrane databases were searched for randomized controlled trials (RCTs) comparing ACEi to standard treatment/placebo for cardiotoxicity prevention in patients undergoing anthracycline-based chemotherapy. We pooled outcomes of echocardiographic and cardiac biomarker changes. A random-effects model was used for all outcomes. We included 7 RCTs with 686 patients, of whom 346 (50%) received prophylaxis with ACEi. The most common malignancy was breast cancer, and the follow-up ranged from 6 to 31 months. Prophylactic use of ACEi was associated with a significantly smaller reduction in left ventricular ejection fraction (LVEF) compared to the control group (mean difference -5% 95% CI -8% - -2%; p<0.010). Subgroup analysis limited to studies excluding trastuzumab from the chemotherapy regimens showed no significant difference (MD -7% 95% CI - 16% - 2%; p=0.110). In contrast, in studies including trastuzumab-containing regimens, ACEi demonstrated a statistically significant effect in limiting LVEF reduction (MD -3%, 95% CI -4 - -1; p<0.010). Diastolic function (E/A ratio) changes (MD 0.0 95% CI -0.1 - 0.09; I2=36.3%) and relative risk of increased troponin I at follow-up (RR 0.58 95% CI 0.17 - 1.94; I2=69.6%) were not statistically significant. Prophylactic ACEi administration in patients undergoing anthracycline-based chemotherapy was associated with a smaller decline in LVEF. This protective role may be more relevant in patients also receiving trastuzumab. More powered and longer follow-up studies are needed to confirm these findings.
Pizzi et al. (Tue,) reported a other. Prophylactic ACE inhibitors reduced LVEF decline by 5% (95% CI 2-8%, p<0.01) in anthracycline chemotherapy patients, with greater effect in trastuzumab regimens.