Primary cardioprotective therapy with perindopril, bisoprolol, and trimetazidine reduced 12-month all-cause mortality compared to no therapy (5.1% vs 11.7%, p=0.04) in high-risk cancer patients.
Observational (n=92)
No
Does primary cardioprotective therapy with perindopril, bisoprolol, and trimetazidine prevent cardiotoxicity and improve outcomes in high-risk cancer patients receiving anthracyclines and/or trastuzumab?
In high-risk cancer patients receiving cardiotoxic chemotherapy, primary cardioprotection with perindopril, bisoprolol, and trimetazidine prevents adverse cardiac remodeling and reduces one-year all-cause mortality.
Absolute Event Rate: 5.1% vs 11.7%
p-value: p=0.04
12028 Background: Anthracyclines and trastuzumab are the most common antitumor agents associated with a substantial risk of cardiotoxicity (CTX). Patients with high or very high cardiovascular risk represent a vulnerable population where even subclinical myocardial injury can translate into clinically significant cardiac dysfunction. The present study is aimed to evaluate the efficacy of primary cardioprotective therapy (CPT) in preventing both subclinical and overt CTX in high-risk patients undergoing anthracycline (A)- and/or trastuzumab (T)-containing treatment. Methods: This single-center prospective observational study included 92 cancer patients (pts) with high or very high risk of CTX according to the Mayo Clinic risk score. The study population consisted of 7 men (8%) and 85 women (92%), with a mean age of 60.6 ± 11.8 years. Breast cancer (BC) was the most common diagnosis (n = 84; 91%), while gastric cancer (GC) accounted for 8 cases (9%). 17 (33.3%) pts in the intervention group and 16 (39%) pts in the control group had a history of congestive heart failure. AC (doxorubicin/cyclophosphamide) regimen was administered in 54 BC patients, AC followed by T in 30 BC pts, T – in 8 GC pts. The intervention group (n = 51) received primary CPT with perindopril and bisoprolol; trimetazidine was added in patients at very high cardiovascular risk or with established coronary artery disease. The control group (n = 41) did not receive CPT due to intolerance or refusal. Echocardiography with left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS), 24-hour blood pressure monitoring, and multibiomarker assessment (troponin I, NT-proBNP, MPO, sST2) were performed at baseline and at 1, 3, 6, 9, and 12 months. Results: The control group showed a significant increase in indexed left atrial volume and indexed left ventricular end-diastolic volume at 6 and 9 months, respectively, indicating cardiac remodeling, which represents one of the earliest manifestations of subclinical cardiotoxicity. GLS reduction ≥18% occurred in 21.2% of control pts vs. 7.1% in the intervention group (p < 0.05). Clinically significant cardiotoxicity with LVEF decline developed in 6 control pts vs. 1 in the intervention group. Cardiovascular complications were 2.5 times more frequent in the control group (70.1% vs. 24.8%). All-cause mortality at 12 months was significantly higher in the control group (11.7% vs. 5.1%, p = 0.04). Conclusions: In high-risk pts with BC and GC receiving anthracycline- and trastuzumab-containing therapy, primary CPT with perindopril, bisoprolol, and trimetazidine effectively prevents adverse cardiac remodeling, preserves myocardial systolic function, reduces the incidence of cardiovascular complications, and is associated with a significant reduction in one-year all-cause mortality.
Khatkova et al. (Wed,) conducted a observational in Breast and gastric cancer with high cardiovascular risk (n=92). Perindopril, bisoprolol, and trimetazidine vs. No cardioprotective therapy was evaluated on All-cause mortality at 12 months (p=0.04). Primary cardioprotective therapy with perindopril, bisoprolol, and trimetazidine reduced 12-month all-cause mortality compared to no therapy (5.1% vs 11.7%, p=0.04) in high-risk cancer patients.