Liu Runyu, Fan Cong, Liu Xiaoling, Li Mengmeng, Zhang Yuan, Zhang Mei
State Key Laboratory for Innovation and Transformation of Luobing Theory, Jinan, China.
Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Jinan, China.
Cardiooncology. 2025 Jul 7;11(1):65. doi: 10.1186/s40959-025-00332-7.
Anthracycline-induced cardiotoxicity is a significant concern for breast cancer patients undergoing treatment, often leading to chronic cardiovascular complications and reduced long-term survival. The study aimed to systematically evaluate the efficacy of nine classes of pharmacological agents in protecting against cardiotoxicity in breast cancer patients treated with anthracyclines.
A comprehensive search of databases was performed from January 2000 to October 2024 to identify randomized controlled trials (RCTs) investigating cardioprotective agents. The risk of bias in the studies was evaluated using the Cochrane risk-of-bias tool. Bayesian network meta-analysis was conducted in Stata 15.1.
Of 3718 studies identified, 29 RCTs involving 2599 patients were included in the network systematic review. The study found that trimetazidine significantly improved left ventricular ejection fraction (LVEF), with a Surface Under the Cumulative Ranking (SUCRA) of 94.0%. The combination of angiotensin-converting enzyme inhibitor or angiotensin receptor blocker with beta-blocker (AA-BB) significantly improved global longitudinal strain (GLS), with a SUCRA of 72.8%. Dexrazoxane was highly effective, significantly reducing B-type natriuretic peptide (BNP) levels, cardiac troponin (cTn) levels, and the E/e' ratio (ratio of the mitral early filling velocity to the mean early relaxation tissue velocity), with SUCRA values of 98.9%, 98.2%, and 99.9%, respectively. Additionally, mineralocorticoid receptor antagonist (MRA) showed the highest SUCRA of 88.4% for improving the E/A ratio (ratio of the mitral early diastolic velocity to the late diastolic velocity).
Trimetazidine, ACEI/ARB, beta-blocker, dexrazoxane, and MRA demonstrate potential as cardioprotective agents in breast cancer patients undergoing anthracycline chemotherapy. Further research is needed to elucidate the specific cardioprotective mechanisms against anthracycline-induced cardiotoxicity.
蒽环类药物引起的心脏毒性是接受治疗的乳腺癌患者的一个重大问题，常常导致慢性心血管并发症并降低长期生存率。该研究旨在系统评估九类药物制剂对接受蒽环类药物治疗的乳腺癌患者预防心脏毒性的疗效。
对2000年1月至2024年10月的数据库进行全面检索，以识别研究心脏保护剂的随机对照试验（RCT）。使用Cochrane偏倚风险工具评估研究中的偏倚风险。在Stata 15.1中进行贝叶斯网络荟萃分析。
在识别出的3718项研究中，网络系统评价纳入了29项涉及2599名患者的RCT。研究发现，曲美他嗪显著改善左心室射血分数（LVEF），累积排序曲线下面积（SUCRA）为94.0%。血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂与β受体阻滞剂的联合使用（AA-BB）显著改善整体纵向应变（GLS），SUCRA为72.8%。右丙亚胺非常有效，显著降低B型利钠肽（BNP）水平、心肌肌钙蛋白（cTn）水平以及E/e'比值（二尖瓣早期充盈速度与平均早期舒张组织速度之比），SUCRA值分别为98.9%、98.2%和99.9%。此外，盐皮质激素受体拮抗剂（MRA）在改善E/A比值（二尖瓣舒张早期速度与舒张晚期速度之比）方面显示出最高的SUCRA，为88.4%。
曲美他嗪、ACEI/ARB、β受体阻滞剂、右丙亚胺和MRA在接受蒽环类化疗的乳腺癌患者中显示出作为心脏保护剂的潜力。需要进一步研究以阐明针对蒽环类药物引起的心脏毒性的具体心脏保护机制。
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