Role of ACE inhibitors in anthracycline‐induced cardiotoxicity: A randomized, double‐blind, placebo‐controlled trial

Gupta, Vineeta; Singh, Sarita; Agrawal, Vikas; Singh, Tej Bali

doi:10.1002/pbc.27308

Cited by 44 publications

(33 citation statements)

References 24 publications

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“…Timely detection of cardiotoxicity in children undergoing anthracycline chemotherapy is crucial because early cardioprotective therapy may prevent or mitigate cardiotoxicity . Echocardiography serves as the primary tool for the detection of LV dysfunction, but clinically apparent changes can be a delayed phenomenon and are therefore limited as an early indicator for the need of cardioprotective interventions .…”

Section: Discussionmentioning

confidence: 99%

“…Only few studies cover the response of cardiac biomarkers to cardioprotective therapy in children receiving anthracyclines . The frequency of troponin elevations was reduced when children received concomitant therapy with the cardioprotective iron chelator dexrazoxane .…”

Section: Discussionmentioning

confidence: 99%

“…The frequency of troponin elevations was reduced when children received concomitant therapy with the cardioprotective iron chelator dexrazoxane . Heart failure therapy with ACE inhibitors or beta‐blockers has also shown to reduce troponin levels in children treated with anthracyclines, but an association between troponin and LV function in this setting has not yet been demonstrated . In adult cancer patients, elevated troponin was successfully used as a marker for high‐risk patients to initiate cardioprotective treatment for the prevention of LV dysfunction .…”

Section: Discussionmentioning

confidence: 99%

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Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer—a meta‐analysis

et al. 2020

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Aims Childhood cancer therapy is associated with a significant risk of therapy-related cardiotoxicity. This meta-analysis aims to evaluate cardiac biomarkers for the detection of cancer therapy-related left ventricular (LV) dysfunction in childhood cancer patients. Methods and results PubMed, Cochrane Library, Wiley Library, and Web of Science were screened for studies investigating brain natriuretic peptide (BNP)/N-terminal proBNP (NT-proBNP) or cardiac troponin in childhood cancer patients. The odds ratios (OR) for elevation of cardiac biomarkers and association with LV dysfunction were calculated using a random-effects model. Data from 27 studies with 1651 subjects were included. BNP/NT-proBNP levels were higher post-treatment compared with controls or pre-treatment values [standardized mean difference = 1.0; 95% confidence interval (CI) = 0.6-1.4; n = 320; P < 0.001]. LV dysfunction was present in 11.76% of included patients, and risk for LV dysfunction was increased in patients with elevated BNP/NT-proBNP (OR = 7.1; 95% CI = 2.0-25.5; n = 350; P = 0.003). The sensitivity of BNP/NT-proBNP for the detection of LV dysfunction was 33.3%, and the specificity was 91.5%. Sensitivity increased when selecting for studies that assessed patients < 5 years after anthracycline exposure and for studies including high cumulative anthracycline doses. Anthracycline chemotherapy was associated with an increased frequency of elevated troponin (OR = 3.7; 95% CI = 2.1-6.5; n = 348; P < 0.001). The available evidence on the association between elevated troponin and LV dysfunction was insufficient for an adequate analysis. In five included studies, the frequency of LV dysfunction was not increased in patients with elevated troponin (OR = 2.5; 95% CI = 0.5-13.2; n = 179; P = 0.53). Conclusions BNP/NT-proBNP is associated with cardiotoxicity in paediatric cancer patients receiving anthracycline therapy, but owing to low sensitivity, BNP/NT-proBNP has to be evaluated in the context of further parameters including clinical assessment and echocardiography. Future studies are needed to determine whether troponin serves as a marker for cardiotoxicity in children. Standardized recommendations for the application of cardiac biomarkers in children undergoing cardiotoxic cancer therapy may benefit management and clinical outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer—a meta‐analysis

et al. 2020

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“…An absolute decrease in EF ≥ 20% from baseline was seen in 3 patients in the placebo group but none in enalapril group (P = 0.21). Concentrations of proBNP (P < 0.001) and cTnI (P = 0.04) were higher in the placebo group [105].…”

Section: Clinical Studies In Childrenmentioning

confidence: 86%

“…Enalapril was evaluated as a cardioprotectant in a randomized, double blind, placebo-controlled trial of 41 children with leukemia and 43 with lymphoma who received anthracyclines (doxorubicin, daunorubicin, or both) at a cumulative dose of ≥200 mg/m 2 [105]. The 44 children in the treatment group received enalapril, 0.1 mg/kg/day, once a day from the first day of chemotherapy for 6 months; the remaining 40 children received a placebo.…”

Section: Clinical Studies In Childrenmentioning

confidence: 99%

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

et al. 2019

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Cancer diagnostics and therapies have improved steadily over the last few decades, markedly increasing life expectancy for patients at all ages. However, conventional and newer anti-neoplastic therapies can cause short-and long-term cardiotoxicity. The clinical implications of this cardiotoxicity become more important with the increasing use of cardiotoxic drugs. The implications are especially serious among patients predisposed to adverse cardiac effects, such as youth, the elderly, those with cardiovascular comorbidities, and those receiving additional chemotherapies or thoracic radiation. However, the optimal strategy for preventing and managing chemotherapyinduced cardiotoxicity remains unknown. The routine use of neurohormonal antagonists for cardioprotection is not currently justified, given the marginal benefits and associated adverse events, particularly with long-term use. The only United States Food and Drug Administration and European Medicines Agency approved treatment for preventing anthracycline-related cardiomyopathy is dexrazoxane. We advocate administering dexrazoxane during cancer treatment to limit the cardiotoxic effects of anthracycline chemotherapy.

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Candesartan and carvedilol for primary prevention of subclinical cardiotoxicity in breast cancer patients without a cardiovascular risk treated with doxorubicin

et al. 2021

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Role of ACE inhibitors in anthracycline‐induced cardiotoxicity: A randomized, double‐blind, placebo‐controlled trial

Abstract: Enalapril has a role in reducing cardiac toxicity after anthracycline administration.

Cited by 44 publications

References 24 publications

Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer—a meta‐analysis

Cardiac biomarkers for the detection of cardiotoxicity in childhood cancer—a meta‐analysis

Strategies to prevent anthracycline-induced cardiotoxicity in cancer survivors

Candesartan and carvedilol for primary prevention of subclinical cardiotoxicity in breast cancer patients without a cardiovascular risk treated with doxorubicin

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