Biomarker and Imaging-Guided Cardioprotection for the Prevention of Anthracycline-Induced Cardiotoxicity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Background & Objective: Anthracycline-based chemotherapy is linked with CTRCD, which may impair cardiovascular function and oncologic outcomes. This systematic review and meta-analysis assessed the clinical benefit of biomarker- and imaging-guided cardioprotective strategies in reducing anthracycline-induced cardiac damage. We postulated that biomarker- or imaging-guided cardioprotective management would better maintain cardiac function and decrease cardiotoxicity relative to conventional care in individuals receiving anthracycline-based chemotherapy. Methodology: A systematic review and meta-analysis were performed according to PRISMA guidelines. Randomized controlled trials including adult patients with cancer, receiving anthracycline-based chemotherapy and preserving baseline LVEF were considered. Eligible strategies included cardioprotective therapy proposed by global longitudinal strain (GLS), cardiac troponin (cTn), or N-terminal pro B-type natriuretic peptide (NT-proBNP), correlated with conventional care or standard monitoring. Research involving pediatric populations, non-anthracycline regimens, observational or non-randomized designs, and those without relevant cardiac outcomes were wasted. The outcomes included LVEF, GLS, overall adverse events, dizziness, worsening renal function, and fatigue. Results: Five randomized controlled trials, including 1,360 participants, were included. Biomarker- or imaging-guided cardioprotection was linked to improved LVEF (SMD 0.17, 95% CI 0.02–0.33; P=0.03) and GLS (SMD −0.24, 95% CI −0.40 to −0.08; P=0.003). No significant differences were observed in overall adverse events (RR 1.43, 95% CI 0.88–2.33; P=0.15), dizziness (RR 5.59, 95% CI 0.63–49.99; P=0.12), worsening renal function (RR 0.99, 95% CI 0.26–3.82; P=0.99), or fatigue (RR 0.49, 95% CI 0.06–3.91; P=0.50). Conclusion: Biomarker- and imaging-guided cardioprotective strategies were seen to be implementable and clinically beneficial for the early detection of anthracycline-associated early cardiotoxicity. These strategies may facilitate earlier initiation of cardioprotective therapy and substantially reduce the risk of CTRCD. Key Words: Cardio-protection, Anthracycline, Cardiotoxicity.