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Review
. 2023 Jan 13;15(2):512.
doi: 10.3390/cancers15020512.

Natural Progression of Left Ventricular Function following Anthracyclines without Cardioprotective Therapy: A Systematic Review and Meta-Analysis

Ainsley Ryan Yan Bin Lee  1 , Chun En Yau  1 , Chen Ee Low  1 , Jiaqi Li  2 , Sara Moiz Tyebally  3 , Weiqin Lin  1   4 , Li-Ling Tan  1   4 , Chia-Te Liao  5   6   7 , Wei-Ting Chang  5   8 , Matilda Xinwei Lee  9 , Chieh-Yang Koo  3   4 , Ching-Hui Sia  1   4
Affiliations
Review

Natural Progression of Left Ventricular Function following Anthracyclines without Cardioprotective Therapy: A Systematic Review and Meta-Analysis

Ainsley Ryan Yan Bin Lee et al. Cancers (Basel). .

Abstract

Background: Anthracyclines form the backbone of many systemic chemotherapy regimens but are accompanied by dose-limiting cardiotoxicity. We elucidate the progression and severity of cardiac function over time, in the absence of cardioprotection, which less is known about.

Methods: This PRISMA-guideline-adherent review was registered on PROSPERO (CRD42022373496).

Results: 26 studies met the eligibility criteria including a total of 910 patients. The overall reduction in post-anthracycline pooled mean left ventricular ejection fraction (LVEF) in placebo arms of the included randomised-controlled trials was 4.5% (95% CI, 2.6 to 6.4). The trend in LVEF showed a progressive decline until approximately 180 days, after which there was no significant change. Those receiving a cumulative anthracycline dose of 300 mg/m2 experienced a more profound reduction. The overall pooled risk of a 10% absolute decline in LVEF from baseline, or a decline to an LVEF below 50%, was 17% (95% CI: 11 to 24; I2 = 71%). Sensitivity analyses of baseline LVEF and trastuzumab treatment status did not yield significant differences.

Conclusion: While the mean LVEF decline in patients without cardioprotective therapy was clinically small, a vulnerable subset experienced significant impairment. Further research to best identify those who benefit most from cardioprotective therapies when receiving anthracyclines is required.

Keywords: anthracyclines; breast cancer; cardio-oncology; cardiotoxicity; chemotherapy toxicity; haematological cancer; heart failure.

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Conflict of interest statement

CHS was supported by the National University of Singapore Yong Loo Lin School of Medicine’s Junior Academic Fellowship Scheme. ARYBL is supported by the SingHealth Medical Student Talent Development Award and National University of Singapore Department of Medicine Junior Research Award. The authors declare that there are no conflicts of interest and all funding received was outside the conducted work.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
Cumulative decline in left ventricular ejection fraction (%) over time (days). Whiskers represent 95% confidence interval. Abbreviations: CI, confidence interval; LVEF, left ventricular ejection fraction.
Figure 3
Figure 3
Pooled risk of developing clinically relevant LVEF decline (at least 10% in LVEF from baseline or post-anthracycline LVEF value below 50%).
See this image and copyright information in PMC

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