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. 2022 Jul 5:9:873898.
doi: 10.3389/fcvm.2022.873898. eCollection 2022.

Time-Dependent Effect of Anthracycline-Based Chemotherapy on Central Arterial Stiffness: A Systematic Review and Meta-Analysis

Caroline Schneider  1   2 , Nathalia González-Jaramillo  2   3 , Thimo Marcin  1 , Kristin L Campbell  4 , Thomas Suter  1 , Arjola Bano  1   3 , Matthias Wilhelm  1 , Prisca Eser  1
Affiliations

Time-Dependent Effect of Anthracycline-Based Chemotherapy on Central Arterial Stiffness: A Systematic Review and Meta-Analysis

Caroline Schneider et al. Front Cardiovasc Med. .

Abstract

Background and aims: Anthracycline-based chemotherapy (ANTH-BC) has been proposed to increase arterial stiffness, however, the time-dependency of these effects remain unclear. This systematic review and meta-analysis aimed to investigate the time-dependent effect of ANTH-BC on markers of central aortic stiffness, namely aortic distensibility (AD) and pulse-wave-velocity (PWV) in cancer patients.

Methods: An extensive literature search without language restrictions was performed to identify all studies presenting longitudinal data on the effect of ANTH-BC on either AD and/or central PWV in cancer patients of all ages. An inverse-variance weighted random-effect model was performed with differences from before to after chemotherapy, as well as for short vs. mid-term effects.

Results: Of 2,130 articles identified, 9 observational studies with a total of 535 patients (mean age 52 ± 11; 73% women) were included, of which four studies measured AD and seven PWV. Short-term (2-4 months), there was a clinically meaningful increase in arterial stiffness, namely an increase in PWV of 2.05 m/s (95% CI 0.68-3.43) and a decrease in AD (albeit non-significant) of -1.49 mmHg-1 (-3.25 to 0.27) but a smaller effect was observed mid-term (6-12 months) for PWV of 0.88 m/s (-0.25 to 2.02) and AD of -0.37 mmHg-1 (-1.13 to 0.39). There was considerable heterogeneity among the studies.

Conclusions: Results from this analysis suggest that in the short-term, ANTH-BC increases arterial stiffness, but that these changes may partly be reversible after therapy termination. Future studies need to elucidate the long-term consequences of ANTH-BC on arterial stiffness, by performing repeated follow-up measurements after ANTH-BC termination.

Systematic review registration: [www.crd.york.ac.uk/prospero/], identifier [CRD42019141837].

Keywords: aortic distensibility; breast cancer; lymphoma; pulse-wave-velocity; vasculotoxicity.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart for study inclusion, adapted from the PRISMA statement. Flow chart illustrating the study search, screening and selection processes.
FIGURE 2
FIGURE 2
Graphical illustration of time-dependent adverse effects on arterial stiffness with ANTH-BC relative to baseline values; AD, aortic distensibility; PWV, pulse-wave-velocity.
FIGURE 3
FIGURE 3
Effect of ANTH-BC on AD. Forest plots illustrating the effect of ANTH-BC on AD divided by time-point of assessment into (A) short-term (3–4 months) and (B) mid-term (6–12 months) effects.
FIGURE 4
FIGURE 4
Effect of ANTH-BC on PWV. Forest plot illustrating the effect of ANTH-BC on PWV divided by time-point of assessment into (A) short-term (2–4 months, corresponding to subgroup analysis for CMR) and (B) mid-term (6–12 months) effects.
See this image and copyright information in PMC

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