Current evidence does not demonstrate a significant cardioprotective effect of ivabradine against anthracycline-induced cardiotoxicity (AIC), according to findings from a systematic review and meta-analysis of randomized controlled trials. The analysis was published in Cardio-Oncology. 

The analysis included randomized controlled trials comparing ivabradine with placebo in adult patients receiving anthracycline-based therapy. Literature searches were conducted across PubMed, Cochrane Central, Embase, Web of Science, Google Scholar, Scopus, ClinicalTrials.gov, and reference lists through August 2025. Outcomes assessed included left ventricular ejection fraction (LVEF), heart rate, blood pressure, N-terminal pro-B-type natriuretic peptide (NT-proBNP), and strain-based imaging parameters.

Three trials involving 210 patients met inclusion criteria. Ivabradine showed no significant effect on LVEF compared with placebo (mean difference 0.32%; 95% confidence interval [CI] -0.90 to 1.54; P=0.61). No significant differences were observed in NT-proBNP levels, systolic blood pressure, or diastolic blood pressure.

Heart rate reduction showed a directionally favorable trend with ivabradine but did not reach statistical significance (mean difference -4.11 beats/min; 95% CI -8.69 to 0.46; P=0.08). Strain-based imaging outcomes were inconsistently reported across studies, preventing pooled analysis.

The findings indicate that current evidence remains insufficient to establish a definitive cardioprotective role for ivabradine in AIC. Larger studies using standardized imaging and biomarker endpoints are needed to further define its clinical utility.