Liu Xiaoyu, Ding Ran, Zhang Aihua
School of Nursing, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, China.
Front Cardiovasc Med. 2025 Sep 3;12:1612060. doi: 10.3389/fcvm.2025.1612060. eCollection 2025.
This study evaluates the efficacy of various pharmacological therapies in mitigating the cardiotoxicity associated with anthracycline chemotherapy and furnishes contemporary, evidence-based guidelines and recommendations for clinical practice.
We searched the EMBASE, Cochrane Library, PubMed, Web of Science, and Scopus databases from the beginning of each database to April 2024 and were limited to English-language documents. The primary objective of this study is to assess the efficacy of cardioprotective drugs in preventing the reduction of left ventricular ejection fraction (LVEF) and the incidence of cardiac events. The secondary objective is to evaluate the impact of these drugs on reducing left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD), as well as on maintaining the ratio of peak mitral annular diastolic velocity to atrial contraction velocity (E/A ratio).
54,852 studies were retrieved from five databases, and 28 randomized controlled trials involving 2,858 patients were finally included. Network Meta-analysis results showed that, compared to the control group, Spironolactone demonstrated the most significant improvement in (LVEF [MD = 12.10, 95% CI (7.50, 16.70)] and LVESD [MD = -5.00, 95% CI (-7.68, -2.32)]. For reducing cardiac events, Dexrazoxane [OR = 0.28, 95% CI (0.16, 0.50)] and Vitamin E combined with Levocarnitine [OR = 0.27, 95% CI (0.08, 0.90)] were the most effective interventions. In terms of diastolic function (E/A ratio), Nebivolol outperformed other β-blockers [MD = 0.23, 95% CI (0.09, 0.37)]. However, no intervention demonstrated a statistically significant effect on LVEDD.
According to the research findings, Spironolactone and Dexrazoxane significantly prevent the decline in LVEF and the occurrence of cardiac events compared to placebo or conventional chemotherapy, with statistical significance. This discovery provides valuable reference for the clinical prevention of anthracycline chemotherapy-induced cardiotoxicity, contributing to the optimization of treatment regimens, reduction of cardiac toxicity risks in patients, and improvement of prognosis.
PROSPERO (CRD42024567684).
本研究评估了各种药物疗法在减轻蒽环类化疗相关心脏毒性方面的疗效，并为临床实践提供了当代基于证据的指南和建议。
我们检索了EMBASE、Cochrane图书馆、PubMed、Web of Science和Scopus数据库，检索时间从每个数据库创建之初至2024年4月，且仅限于英文文献。本研究的主要目的是评估心脏保护药物在预防左心室射血分数（LVEF）降低和心脏事件发生率方面的疗效。次要目的是评估这些药物对减小左心室收缩末期内径（LVESD）和左心室舒张末期内径（LVEDD）的影响，以及对维持二尖瓣环舒张期峰值速度与心房收缩速度之比（E/A比值）的影响。
从五个数据库中检索到54,852项研究，最终纳入28项涉及2,858例患者的随机对照试验。网络Meta分析结果显示，与对照组相比，螺内酯在LVEF[MD = 12.10，95%CI（7.50，16.70）]和LVESD[MD = -5.00，95%CI（-7.68，-2.32）]方面表现出最显著的改善。在降低心脏事件方面，右丙亚胺[OR = 0.28，95%CI（0.16，0.50）]以及维生素E联合左卡尼汀[OR = 0.27，95%CI（0.08，0.90）]是最有效的干预措施。在舒张功能（E/A比值）方面，奈必洛尔优于其他β受体阻滞剂[MD = 0.23，95%CI（0.09，0.37）]。然而，没有干预措施对LVEDD显示出统计学上的显著效果。
根据研究结果，与安慰剂或传统化疗相比，螺内酯和右丙亚胺能显著预防LVEF下降和心脏事件的发生，具有统计学意义。这一发现为临床预防蒽环类化疗所致心脏毒性提供了有价值的参考，有助于优化治疗方案，降低患者心脏毒性风险，改善预后。
PROSPERO（CRD42024567684）。
