Renin-angiotensin System Antagonists and Beta-blockers in Prevention of Anthracycline Cardiotoxicity: a Systematic Review and Meta-analysis

Abstract Background The evidence supporting the use of renin-angiotensin-aldosterone system (RAAS) inhibitors and beta-blockers for the prevention of anthracycline-induced cardiomyopathy is controversial. Objective We performed a meta-analysis to assess the effectiveness of these drugs in preventing cardiotoxicity. Methods The meta-analysis included prospective, randomized studies in adults receiving anthracycline chemotherapy and compared the use of RAAS inhibitors or beta-blockers versus placebo with a follow-up of 6 to 18 months. The primary outcome was change in left ventricular ejection fraction (LVEF) during chemotherapy. Secondary outcomes were the incidence of heart failure, all-cause mortality, and changes in end-diastolic measurement. Heterogeneity was assessed by stratification and meta-regression. A significance level of p摘要 背景：目前支持使用肾素-血管紧张素-醛固酮系统（renin-angiotensin-aldosterone system, RAAS）抑制剂与β受体阻滞剂（beta-blockers）预防蒽环类药物诱导型心肌病的相关证据尚存争议。 研究目的：本研究开展荟萃分析，以评估上述药物在预防心脏毒性方面的临床有效性。 研究方法：本荟萃分析纳入接受蒽环类化疗的成人受试者的前瞻性随机对照研究，对比RAAS抑制剂或β受体阻滞剂与安慰剂的干预效果，随访时长为6至18个月。主要结局指标为化疗期间左心室射血分数（left ventricular ejection fraction, LVEF）的变化；次要结局指标包括心力衰竭发生率、全因死亡率及舒张末期测量值的变化。采用分层分析与Meta回归评估研究间异质性，显著性检验水准设定为p值。