Barbosa Roberto Ramos, Bourguignon Taissa Borges, Torres Luíza Dias, Arruda Lorenza Silveira, Jacques Tiago de Melo, Serpa Renato Giestas, Calil Osmar de Araujo, Barbosa Luiz Fernando Machado
. School of Sciences of Santa Casa de Misericórdia de Vitoria, Vitória, ES, Brasil.
Rev Assoc Med Bras (1992). 2018 Aug;64(8):745-754. doi: 10.1590/1806-9282.64.08.745.
This study aimed at assessing the role of beta-blockers on preventing anthracycline-induced cardiotoxicity in adults.
A systematic review was performed on electronic databases, including relevant studies that analysed beta-blockers as cardioprotective agents before the use of anthracyclines by adult oncologic patients.
After application of eligibility and selection criteria, eight articles were considered as high quality, complying with the proposed theme; all eight clinical trials, four of them placebo-controlled, with a total number of 655 patients included. From this sample, 281 (42.9%) used beta-blocker as intervention, and carvedilol was the most frequent (167 patients - 25.5%). Six studies were considered positive regarding the cardioprotection role played by beta-blockers, although only four demonstrated significant difference on left ventricle ejection fraction after chemotherapy on groups that used beta-blockers compared to control groups. Carvedilol and nebivolol, but not metoprolol, had positive results regarding cardioprotection. Other beta-blockers were not analysed in the selected studies.
Despite the potential cardioprotective effect of beta-blockers, as demonstrated in small and unicentric clinical trials, its routine use on prevention of anthracycline-associated cardiotoxicity demands greater scientific evidence.
本研究旨在评估β受体阻滞剂在预防成人蒽环类药物所致心脏毒性中的作用。
对电子数据库进行系统评价，纳入成年肿瘤患者在使用蒽环类药物前将β受体阻滞剂作为心脏保护剂进行分析的相关研究。
应用纳入和选择标准后，8篇文章被认为质量较高，符合拟研究主题；所有8项临床试验中，4项为安慰剂对照试验，共纳入655例患者。在该样本中，281例（42.9%）使用β受体阻滞剂作为干预措施，其中卡维地洛最为常用（167例患者 - 25.5%）。6项研究认为β受体阻滞剂具有心脏保护作用，尽管只有4项研究表明，与对照组相比，使用β受体阻滞剂的化疗组左心室射血分数有显著差异。卡维地洛和奈必洛尔在心脏保护方面有阳性结果，而美托洛尔则没有。所选研究中未对其他β受体阻滞剂进行分析。
尽管在小型单中心临床试验中已证明β受体阻滞剂具有潜在的心脏保护作用，但其在预防蒽环类药物相关心脏毒性方面的常规应用仍需要更多科学证据。
