Heart failure from cancer therapy: can we prevent it?
Heart failure from cancer therapy: can we prevent it?
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DOI：
10.1002/ehf2.12493
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发表时间：
2019-07-11
影响因子：
3.8
通讯作者：
Rassaf, Tienush
中科院分区：
文献类型：
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作者：
Totzeck, Matthias;Mincu, Raluca, I;Rassaf, Tienush
传统的细胞毒性化疗仍然是许多类型癌症最有效的治疗选择之一。然而，心脏毒性，特别是在这些方案下左心室功能的下降，可能会损害预后。因此，预防和治疗心脏毒性至关重要。本荟萃分析旨在评估β受体阻滞剂或血管紧张素转换酶（ACE）抑制剂/血管紧张素II受体阻滞剂（ARB）预防心脏毒性的疗效。方法和结果我们系统地检索了Pubmed、科克伦、EMBASE和Web of Science数据库中截至2019年2月发表的随机对照试验。该分析包括随机研究，这些研究报告了接受β受体阻滞剂或ACE抑制剂/ARB预防心脏毒性的癌症患者与对照组相比化疗6个月后的左心室射血分数（LVEF）。从分析中排除了联合心脏保护治疗的研究。主要终点是预防LVEF降低，由个体研究定义，并通过经胸超声心动图或磁共振成像评估。本研究表明，接受蒽环类药物化疗的患者从β受体阻滞剂或ACE/ARB中获得了中度但显著的LVEF获益。β受体阻滞剂分析包括769例癌症患者，ACE抑制剂/ARB分析包括共计581例癌症患者。β受体阻滞剂组和对照组之间的平均LVEF差异为2.57%（95%置信区间0.63-4.51，P = 0.009）。ACE抑制剂/ARB的平均差异为4.71%（95%置信区间0.38-9.03，P = 0.03）。然而，整个研究的有益效果是可变的，因为研究之间存在显著的异质性。结论：需要系统的证据来确定化疗期间心脏保护性预防的建议。同样，需要对其他神经体液药物（螺内酯）和降脂方法进行试验，以改善对心脏肿瘤患者的保护。
Aims Conventional cytotoxic chemotherapy is still among the most effective treatment options for many types of cancer. However, cardiotoxicity, notably the decrease in left ventricular function under these regimens, can impair prognosis. Thus, prevention and treatment of cardiotoxicity are crucial. The present meta-analysis aims to assess the efficacy of beta-blockers or angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARBs) for prevention of cardiotoxicity. Methods and results We systematically searched Pubmed, Cochrane, EMBASE, and Web of Science databases for randomized controlled trials published until February 2019. The analysis included randomized studies that reported on left ventricular ejection fraction (LVEF) after 6 months of chemotherapy in cancer patients who received beta-blockers or ACE inhibitors/ARBs for prevention of cardiotoxicity compared with controls. Studies on combination cardioprotective therapies were excluded from the analysis. The primary endpoint was prevention of a decrease in LVEF as defined by the individual study and as assessed by either transthoracic echocardiography or magnetic resonance imaging. We here show that patients under anthracycline-based chemotherapy have a moderate yet significant benefit in LVEF from beta-blockers or ACEs/ARBs. The beta-blocker analysis included 769 cancer patients, and the ACE inhibitors/ARBs analysis included a total of 581 cancer patients. The mean LVEF difference between the beta-blocker group and the control group was 2.57% (95% confidence interval 0.63-4.51, P = 0.009). The mean difference for ACE inhibitors/ARBs was 4.71% (95% confidence interval 0.38-9.03, P = 0.03). However, the beneficial effects throughout the studies were variable as documented by significant heterogeneity between the studies. Conclusions Systematic evidence is needed to solidly found recommendations for cardioprotective prevention during chemotherapy. Likewise, trials on other neurohumoral drugs (spironolactone) and lipid-lowering approaches are required to improve protection for cardio-oncology patients.