Dorothy M Gujral1, Guy Lloyd2, Sanjeev Bhattacharyya3. 1. Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK. 2. Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, UCL, UK. 3. Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, London, UK; Institute of Cardiovascular Science, UCL, UK. Electronic address: Sanjeev.Bhattacharyya@bartshealth.nhs.uk.
Abstract
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.
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.
Authors: Carly C Barron; Nidhi Kumar Tyagi; Muhammad Mustafa Alhussein; Som D Mukherjee; Peter M Ellis; Sukhbinder Dhesy-Thind; Darryl P Leong Journal: Oncologist Date: 2019-07-17
Authors: C C Barron; M M Alhussein; U Kaur; T L Cosman; N K Tyagi; M Brown; S D Mukherjee; P M Ellis; S Dhesy-Thind; D P Leong Journal: Curr Oncol Date: 2019-08-01 Impact factor: 3.677
Authors: Naomi Dempsey; Amanda Rosenthal; Nitika Dabas; Yana Kropotova; Marc Lippman; Nanette H Bishopric Journal: Breast Cancer Res Treat Date: 2021-06-11 Impact factor: 4.872