What does this research mean for the field?

Prophylactic ACE inhibitors reduce left ventricular ejection fraction (LVEF) decline by 5% in patients undergoing anthracycline-based chemotherapy, with a particularly significant protective effect in those also receiving trastuzumab. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This research evaluates the effectiveness of ACE inhibitors in preventing heart damage during anthracycline chemotherapy.

March 5, 2026

Cardioprotective effects of prophylactic ACE inhibitors in anthracycline-induced cardiotoxicity: a systematic review and meta-analysis of randomized trials

Key Result

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.

Key Points

This research evaluates the effectiveness of ACE inhibitors in preventing heart damage during anthracycline chemotherapy.
Conducted a systematic review and meta-analysis of randomized controlled trials (RCTs)
Searched databases including PubMed, Embase, and Cochrane
Included trials comparing ACE inhibitors to standard treatment/placebo
Pooled outcomes from echocardiographic and cardiac biomarker changes
Analyzed data from seven RCTs with a total of 686 patients.
Prophylactic ACE inhibitors linked to a smaller reduction in left ventricular ejection fraction (LVEF) compared to controls
Significant difference in LVEF reduction (mean difference -5%, p<0.010)
No significant difference in diastolic function changes or increased troponin I risk
Effect of ACE inhibitors in reducing LVEF decline was more prominent in studies including trastuzumab.

Structured PICO

Does prophylactic ACEi prevent LVEF reduction in patients undergoing anthracycline-based chemotherapy?

Population

686 patients across 7 RCTs undergoing anthracycline-based chemotherapy (most commonly for breast cancer)

Intervention

Prophylactic angiotensin-converting enzyme inhibitors (ACEi) as a class

Comparator

Standard treatment or placebo

Outcome

Reduction in left ventricular ejection fraction (LVEF)surrogate

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.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

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.

Bookmark