Effect of prophylactic betablocker or ACE inhibitor on cardiac dysfunction & heart failure during anthracycline chemotherapy ± trastuzumab
Effect of prophylactic betablocker or ACE inhibitor on cardiac dysfunction & heart failure during anthracycline chemotherapy ± trastuzumab
复制标题
DOI：
10.1016/j.breast.2017.10.010
复制
发表时间：
2018-02-01
期刊：
影响因子：
3.9
通讯作者：
Bhattacharyya, Sanjeev
中科院分区：
文献类型：
--
作者：
Gujral, Dorothy M.;Lloyd, Guy;Bhattacharyya, Sanjeev
背景：蒽环类化疗+/-曲妥珠单抗与心功能障碍相关。我们试图确定预防性给予血管紧张素转换酶（ACE）抑制剂或β受体阻滞剂是否能减轻随后的左心室功能障碍和心力衰竭。方法：检索电子数据库，研究β受体阻滞剂或ACE抑制剂对蒽环类化疗+/-曲妥珠单抗患者左室射血分数（LVEF）和心力衰竭的影响。终点是LVEF的变化或心力衰竭的发展。结果：共纳入8项研究（1048例患者）。在接受ACE抑制剂或对照组之间，LVEF(加权平均差(MWD) -4.74（95%可信区间（CI）： -12.6至3.1）或新心力衰竭诊断风险（优势比（or） 0.24 (95% CI: 0.03-1.73), p = 0.16）的变化无差异。与对照组相比，β受体阻滞剂的使用与LVEF的显著下降相关（MWD -3.28 (95% CI: -6.1至-0.51),p = 0.02），但与单独接受蒽环类化疗的患者无关（MWD -3.05 (95% CI: -7.22至1.12),p = 0.15）。与未接受受体阻滞剂治疗的患者相比，接受受体阻滞剂治疗的患者新发心力衰竭诊断率显著降低（OR 0.33 (95% CI: 0.14-0.80), p = 0.01）。结论：预防性ACE抑制剂不能减轻接受蒽环类化疗+/-曲妥珠单抗的患者左室功能障碍或心衰的发生。受体阻滞剂减弱LVEF降低和新心衰诊断。然而，仅接受蒽环类药物治疗的患者的效果不太确定。对死亡率影响的研究是必要的。(c) 2017 Elsevier Ltd.版权所有。
Background: Administration of anthracycline chemotherapy +/- trastuzumab is associated with cardiac dysfunction. We sought to identify whether prophylactic administration of angiotensin converting enzyme (ACE) inhibitor or beta-blocker attenuates subsequent left ventricular dysfunction and heart failure.Methods: Electronic databases were searched for studies examining the effect of beta-blockers or ACE inhibitors on left ventricular ejection fraction (LVEF) and heart failure in patients receiving anthracycline chemotherapy +/- trastuzumab. The end-point was change in LVEF or development of heart failure.Results: Eight studies (1048 patients) were identified. There was no difference in the change in LVEF (weighted mean difference (MWD) -4.74 (95% confidence interval (CI): -12.6 to 3.1), p = 0.24) or risk of new heart failure diagnosis (Odds ratio (OR) 0.24 (95% CI: 0.03-1.73), p = 0.16) between patients receiving ACE inhibitor or control. Betablocker use was associated with a significant smaller drop in LVEF compared to control (MWD -3.28 (95% CI: -6.1 to -0.51), p = 0.02) but not in patients who received anthracycline chemotherapy alone (MWD -3.05 (95% CI -7.22 to 1.12), p = 0.15). There was a significant reduction in new heart failure diagnosis in those receiving beta-blocker compared to those not (OR 0.33 (95% CI: 0.14-0.80), p = 0.01).Conclusions: Prophylactic ACE inhibitor does not attenuate development of LV dysfunction or heart failure in patients receiving anthracycline chemotherapy +/- trastuzumab. Beta-blocker attenuated reduction in LVEF and new heart failure diagnosis. However, the effect in patients only receiving anthracycline is less certain. Studies examining the effect on mortality are required. (c) 2017 Elsevier Ltd. All rights reserved.