Department of Internal Medicine, Hurley Medical Center/Michigan State University, Flint, Michigan.
Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts.
Am J Cardiol. 2018 Dec 1;122(11):1959-1964. doi: 10.1016/j.amjcard.2018.08.039. Epub 2018 Sep 8.
Anthracycline is a commonly prescribed antineoplastic agent. As a consequence of the growing number of cancer survivors, the incidence of anthracycline-induced cardiotoxicity is increasing. However, the optimal primary preventive strategy is lacking. Therefore, we conducted a meta-analysis of all randomized controlled trials to evaluate the efficacy of carvedilol for the primary prevention of anthracycline-induced cardiotoxicity. A comprehensive search of electronic databases was conducted. The primary and secondary outcomes were the occurrence of low left ventricular ejection fraction, and the absolute change in left ventricular ejection fraction (LVEF), respectively. We calculated the odds ratios for the primary outcome and the weighted mean differences for the secondary outcomes using a random-effects model. We included 8 randomized controlled trials (633 total patients). Our results showed significantly reduced rates of low LVEF favoring the carvedilol group (3.2% vs 5.8%; odds ratios: 0.42; 95% confidence interval: 0.18 to 0.99; p = 0.05). Furthermore, there were significantly smaller reductions in LVEF in carvedilol-treated patients than in placebo-treated patients (mean differences: 2.41%; 95% confidence interval: 0.01 to 4.81; p = 0.05). In conclusion, prophylactic administration of carvedilol in anthracycline-treated cancer patients may reduce the early onset of left ventricular dysfunction compared with placebo.
蒽环类抗生素是一种常用的抗肿瘤药物。由于癌症幸存者人数的增加，蒽环类药物引起的心脏毒性的发生率也在增加。然而，目前缺乏最佳的初级预防策略。因此，我们对所有随机对照试验进行了荟萃分析，以评估卡维地洛预防蒽环类药物心脏毒性的疗效。我们进行了全面的电子数据库检索。主要和次要结局分别是左心室射血分数降低和左心室射血分数（LVEF）的绝对变化。我们使用随机效应模型计算了主要结局的优势比和次要结局的加权均数差值。我们纳入了 8 项随机对照试验（共 633 例患者）。我们的结果表明，卡维地洛组左心室射血分数降低的发生率明显降低（3.2% vs 5.8%；优势比：0.42；95%置信区间：0.18 至 0.99；p = 0.05）。此外，与安慰剂组相比，卡维地洛治疗组的 LVEF 降低幅度明显较小（平均差异：2.41%；95%置信区间：0.01 至 4.81；p = 0.05）。总之，与安慰剂相比，蒽环类药物治疗的癌症患者预防性应用卡维地洛可能会降低左心室功能障碍的早期发生。
