Key result
ACEIs improve LVEF by ~8% at six months but not at 12 months.
Why the study?
Anthracyclines cause dose-dependent cardiotoxicity through oxidative stress and RAS activation, and ACEIs show promise in reducing this damage.
Do angiotensin converting enzyme inhibitors (ACEIs) preserve left ventricular function and reduce cardiotoxicity in patients receiving anthracycline therapy?
Meta-Analysis (n=869)
Do angiotensin converting enzyme inhibitors (ACEIs) preserve left ventricular function and reduce cardiotoxicity in patients receiving anthracycline therapy?
Answers are grounded in this paper and cite their sources.
ACE inhibitors provide short-term preservation of left ventricular ejection fraction in patients undergoing anthracycline chemotherapy, though long-term benefits remain unconfirmed.
BACKGROUND: 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. OBJECTIVES AND DESIGN: 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. METHODS: 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. MAIN OUTCOME MEASURES: The primary outcome was changes in left ventricular ejection fraction (LVEF). Secondary outcomes included cardiac event incidence and adverse events. SAMPLE SIZE: Nine RCTs were included, encompassing 869 patients (440 ACEI group, 429 control group). RESULTS: 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. QUALITY OF EVIDENCE: 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. HETEROGENEITY: High (I²=97%) for LVEF at 6 months. CONCLUSION: ACEIs prevent cardiotoxicity in the short term without increasing adverse events. More extensive trials are needed to confirm long-term benefits. LIMITATIONS: 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. REGISTRATION: PROSPERO CRD42024555546.
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Safwan et al. (2025) conducted a meta-analysis in anthracycline-induced cardiotoxicity (n=869). Angiotensin converting enzyme inhibitors (ACEIs) vs. control was evaluated on changes in left ventricular ejection fraction (LVEF) (MD 7.93%, 95% CI 3.18-12.67, p=.001). Angiotensin converting enzyme inhibitors significantly improved left ventricular ejection fraction at six months (MD 7.93%; 95% CI 3.18-12.67%; P=.001) but not at 12 months.
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