Efficacy of Neurohormonal Therapies in Preventing Cardiotoxicity in Patients With Cancer Undergoing Chemotherapy

JACC. CardioOncology

卷:1

Mark Haykowsky, PhD¹  Javed Butler, MD, MPH, MBA²  Muthiah Vaduganathan, MD, MPH²  Alvin Chandra, MD²  Anju Nohria, MD³  Javid Moslehi, MD⁴  Bonnie Ky, MD, MSCE⁵  Ambarish Pandey, MD, MSCS⁶  Sameer A. Hirji, MD, MPH⁷  Ankur Gupta, MD, PhD⁸  Vlad G. Zaha, MD⁸  Arman Qamar, MD⁹  Navkaranbir Bajaj, MD, MPH¹⁰ 

[1] Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas;

[2] Brigham and Women’s Hospital Heart, Vascular Center, and Harvard Medical School, Boston, Massachusetts;

[3] Cardio-Oncology Program, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;

[4] Cardiovascular Institute, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;

[5] College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas;

[6] Department of Medicine, University of Mississippi, Jackson, Mississippi;

[7] Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;

[8] TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;

[9] University of Alabama at Birmingham, Birmingham, Alabama;

关键词: anthracyclines;    cardioprotection;    cardiotoxicity;    ejection fraction;    heart failure;    meta-analysis;   

DOI  :  

来源: DOAJ

【 摘 要 】

Objectives: This study sought to assess the effects of neurohormonal therapies in preventing cardiotoxicity in patients receiving chemotherapy. Background: Various cardioprotective approaches have been evaluated to prevent chemotherapy-related cardiotoxicity; however, their overall utility remains uncertain. Methods: This meta-analysis included randomized clinical trials of adult patients that underwent chemotherapy and neurohormonal therapies (β-blockers, mineralocorticoid receptor antagonists, or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) versus placebo with follow-up ≥4 weeks. The primary outcome was change in left ventricular ejection fraction (LVEF) from baseline to the end of the trial. Other outcomes of interest were measures of LV size, strain, and diastolic function. Pooled estimates for each outcome were reported as standardized mean difference and weighted mean difference between the neurohormonal therapy and placebo groups using random effects models. Results: We included 17 trials, collectively enrolling 1,984 participants. In pooled analysis, neurohormonal therapy (vs. placebo) was associated with significantly higher LVEF on follow-up (standardized mean difference: +1.04 [95% confidence interval (CI): 0.57 to 1.50]) but with significant heterogeneity in the pooled estimate (I2 = 96%). Compared with placebo-treated patients, those randomized to neurohormonal therapies experienced a 3.96% (95% CI: 2.90 to 5.02) less decline in LVEF estimated by weighted mean difference, but with significant heterogeneity (I2 = 98%). There was a trend toward lower adverse clinical events with neurohormonal therapy (vs. placebo) that did not meet statistical significance (risk ratio: 0.80 [95% CI: 0.53 to 1.20]; I2 = 71%). Conclusions: Neurohormonal therapies are associated with higher LVEF in follow-up among cancer patients receiving chemotherapy, although absolute changes in LVEF are small and may be within inter-test variability. Furthermore, significant heterogeneity is observed in the treatment effects across studies highlighting the need for larger trials of cardioprotective strategies.

【 授权许可】

Unknown