Meta-analysis Of ACEI/ARB In Preventing Cardiovascular Injury Caused By Anthracyclines

Objective:To systematically evaluate the role of ACEI and ARBs in preventing cardiotoxicity induced by anthracyclines in adult patients,and provide a more specific plan for clinical treatment,and provide new evidence for delaying the occurrence of cardiovascular toxicity caused by anthracyclines and improving the survival rate and quality of life of patients.Methods:By searching Pubmed,Embase,Web of Science and Cochrane databases from the establishment of the database to September 20,2022 in English only,two authors independently screened relevant literature,extracted data and evaluated the methodological quality of included studies in strict accordance with inclusion and exclusion criteria.Meta-analysis was performed using Revman software.In the meta-analysis,dichotomous variables were used to calculate the RR values of heart injury and hypotension and the corresponding 95% confidence interval(95%CI),and random effects model was used to calculate the continuous variables left ventricular ejection fraction(LVEF)and mean difference of E/A(MD).Results:A total of 705 literatures were obtained.Five randomized controlled clinical studies with a total of 333 patients were included in a meta-analysis that showed a slight improvement in left ventricular ejection fraction after prophylactic use of an angiotensin converting enzyme inhibitor or angiotensin receptor blocker.However,the difference was not statistically significant compared with the control group(MD=3.22,95%CI[-2.01,8.46],P=0.23).Subgroup analysis showed that prophylactic use of ACEI/ARB had a significant protective effect in the early stage compared with the control group,the difference was statistically significant(MD=4.00,95%CI[0.91,7.09],P=0.01),but with the extension of follow-up time,the protective effect decreased,and the difference was not statistically significant compared with the control group.Compared with the control group,prophylactic use of ACEI/ARB did not improve left ventricular stretch function(MD=-0.00,95%CI[-0.08,0.07],P=0.90).The incidence of heart injury in the experimental group(8.8%)was lower than that in the control group(12.3%),but there was no significant difference between the two groups(RR=0.93,95% CI[0.09,9.18],P=0.95).In the safety analysis of the experimental group,the incidence of hypotension in the experimental group was lower,and there was no statistical significance compared with the control group(RR=4.81,95%CI[0.58,39.72],P=0.14).Conclusion:Prophylactic use of an angiotensin-converting enzyme inhibitor or an angiotensin-receptor antagonist slightly improved left ventricular ejection fraction in patients treated with anthracyclines compared with the control group,but the effect was insignificant.Prophylactic use of ACEI/ARB did not improve left ventricular stretch function.More randomized controlled trials with large samples and long follow-up times are needed to evaluate the effect of prophylactic use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers on cardiotoxicity induced by anthracyclines.