Cancer therapy-related cardiac dysfunction (CTRCD) remains a significant challenge despite advances in oncologic treatment that have improved long-term cancer survival. Current cardioprotective approaches have demonstrated variable success in preventing declines in cardiac function, prompting interest in therapies that may better preserve myocardial performance during chemotherapy.
A systematic review and meta-analysis published in the Cardiology in Review evaluated the effects of sacubitril/valsartan on cardiac outcomes in patients undergoing chemotherapy. The analysis included four randomized controlled trials involving 412 patients. Primary outcomes were the incidence of cancer therapy-related cardiac dysfunction (CTRCD) and changes in left ventricular ejection fraction (LVEF). Additional assessments included global longitudinal strain (GLS), adverse events, mortality, heart failure, and treatment discontinuation.
Findings
- Sacubitril/valsartan was associated with greater preservation of LVEF compared with control therapy (mean difference, 1.71%; 95% CI, 0.73–2.68; P<0.001).
- Patients receiving sacubitril/valsartan demonstrated greater improvement in GLS, a marker of subclinical myocardial function (mean difference, –0.99; 95% CI, –1.94 to –0.04; P=0.04).
- No significant difference was observed in the incidence of CTRCD between treatment groups (RR, 0.44; 95% CI, 0.15–1.32; P=0.14).
- Sacubitril/valsartan was associated with a significantly higher risk of hypotension compared with controls (RR, 4.35; 95% CI, 1.71–11.08; P=0.001).
- No significant differences were observed for death (P=0.86), heart failure events (P=0.52), or treatment discontinuation due to adverse events (P=0.75).
The findings suggest that sacubitril/valsartan may help preserve left ventricular function and improve subclinical measures of myocardial performance in patients receiving chemotherapy. However, the treatment was associated with an increased risk of hypotension and did not significantly reduce the incidence of CTRCD in this analysis.
