Document Type : Original Article(s)
Authors
1 Department of Cardiology, Najafabad Branch, Islamic Azad University, Najafabad, Isfahan, Iran
2 Department of Internal Medicine, Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
3 Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Anthracyclines are cornerstone agents in breast cancer chemotherapy. However, they can cause dose-dependent cardiotoxicity, potentially impairing long-term cardiac function. Beta-blockers have demonstrated cardioprotective effects. However, evidence regarding bisoprolol, particularly using comprehensive echocardiographic evaluations, remains limited. This study aimed to evaluate the cardioprotective effects of low-dose bisoprolol against anthracycline-induced subclinical cardiac dysfunction in patients with breast cancer.
Methods: This triple-blind, randomized controlled trial was conducted in Isfahan, Iran, between January and December 2023. Eligible women with locally advanced breast cancer receiving anthracycline-based chemotherapy were randomized to bisoprolol (2.5 mg/day) or a placebo. Cardiac function was assessed at baseline, mid-treatment, and the end of treatment during a 6-month follow-up period. The evaluated echocardiographic parameters included left ventricular ejection fraction (LVEF), left ventricular end-diastolic and end-systolic dimensions (LVEDD, LVESD), left ventricular end-diastolic volume (LVEDV), global longitudinal strain (GLS), and tricuspid annular systolic excursion (TAPSE). Statistical analyses were performed using SPSS software (version 25.0). Continuous variables were analyzed using paired or independent-samples t tests, and categorical variables were analyzed using the Chi square test. Statistical significance was defined as P<0.05.
Results: A total of 50 patients completed the trial (25 in the bisoprolol group and 25 in the placebo group). LVEF remained stable in both groups. Compared with the placebo group, bisoprolol demonstrated significantly more favorable structural and functional changes, including a reduction in LVEDD (mean change=-0.172 cm; 95% CI=-0.343 to -0.001; P=0.049), LVESD (mean change=-0.156 cm; 95% CI=-0.295 to -0.172; P=0.029), and LVEDV (mean change=-7.920 mL; 95% CI=-15.174 to -0.666; P=0.033); improved GLS (mean change=0.974; 95% CI=0.083 to 1.865; P=0.033); and better preserved TAPSE (mean change=0.168 cm; 95% CI=0.101 to 0.234; P<0.001).
Conclusion: Prophylactic bisoprolol might attenuate early subclinical cardiotoxicity in patients with breast cancer receiving anthracyclines, primarily through the stabilization of LVEDV and a more favorable GLS trajectory.
Iranian Registry of Clinical Trials: IRCT20130701013828N8
Highlights
Ahmad Mirdamadi (Google Scholar)
Hamidreza Mohseni (Google Scholar)
Keywords
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