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Preventing anthracycline-induced cardiotoxicity with ivabradine: A systematic review and meta-analysis
Rohab Sohail, Ridda Khattak, Haider Hussain Shah, Zaraq Khan, Shafaq Jawed, Asad Ullah Wasim, Bisma Akram, Rohan Patel, Simran Patel, Madihah Alam, Shahryar Chaudhry, Samar Mehdi, Vyom Patel, Manjeet Singh
Rohab Sohail, Ridda Khattak, Rohan Patel, Simran Patel, Madihah Alam, Shahryar Chaudhry, Samar Mehdi, Department of Internal Medicine, Bayhealth Medical Center, Dover, DE 19904, United States
Haider Hussain Shah, Department of Medicine, Bayhealth Hospital, Kent Campus, Dover, DE 19901, United States
Zaraq Khan, Vyom Patel, Department of Internal Medicine, Indiana University School of Medicine, Southwest Internal Medicine Residency Program, Evansville, IN 46202, United States
Shafaq Jawed, Department of Internal Medicine, HCA healthcare system, Houston, TX 77090, United States
Asad Ullah Wasim, Department of Internal Medicine, Northwest Medical Center, Tucson, AZ 85741, United States
Bisma Akram, Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan
Manjeet Singh, Department of Cardiology and Cardiovascular Diseases, Bayhealth Medical Center, Dover, DE 19904, United States
Author contributions: Sohail R, Khattak R, Shah HH contributed to conceptualization; Sohail R, Khattak R, Shah HH, Khan Z, Jawed S, Wasim AU, Akram B, Patel R, Patel S, Alam M, Chaudhry S, Mehdi S, and Patel V contributed to writing-original draft; Sohail R and Khattak R contributed to validation; Sohail R contributed to methodology, formal analysis, software; Shah HH contributed to project administration; Patel V contributed to visualization; Singh M contributed to writing-review and editing and supervision.
AI contribution statement: ChatGPT was used for language polishing, translation, and writing assistance. No AI tools were used in data analysis or generation of figures.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. A similar study abstract has been presented at American Heart Association scientific sessions in 2025; full text has not been published anywhere previously.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Rohab Sohail, MD, Department of Internal Medicine, Bayhealth Medical Center, 640 South State Street, Dover, DE 19904, United States.
rohabsohail98@gmail.com
Received: March 25, 2026
Revised: April 20, 2026
Accepted: May 28, 2026
Published online: July 26, 2026
Processing time: 114 Days and 17.6 Hours
BACKGROUND
Anthracyclines by generating reactive oxygen species (ROS), causes a dose-dependent, irreversible myocardial injury, resulting in cardiomyopathy and congestive heart failure. Ivabradine is speculated to provide cardio protection against anthracyclines by lowering heart rate, reducing oxygen demand, and preserving coronary microcirculation Our meta-analysis aims to provide a comprehensive conclusion to this association.
AIM
To investigate the efficacy of Ivabradine in prevention of anthracycline-induced cardiotoxicity.
METHODS
PubMed and Google Scholar were searched for randomized controlled trials (RCTs) comparing Ivabradine to placebo in patients receiving Anthracycline based chemotherapy. After careful screening 3 studies including 210 patients were analyzed using a random-effects model in RevMan 5.4.1 and results were generated in form of relative risk (RR) and mean difference (MD).
RESULTS
Ivabradine failed to show any statistical significant reduction in; troponin [SMD = 0.10; 95% confidence interval (95%CI): -2.14 to 2.33; P = 0.93], NT-proBNP (SMD = 0.26; 95%CI: -1.39 to 1.92; P = 0.76), systolic blood pressure (SMD = -0.13; 95%CI: -0.44 to 0.19; P = 0.43), diastolic blood pressure (SMD = -0.16; 95%CI: -047 to 0.16; P = 0.33), global longitudinal strain reduction (RR = 0.80; 95%CI: 0.28-2.32; P = 0.68), or left ventricular ejection fraction (SMD = –0.01; 95%CI: -0.28 to 0.26; P = 0.95).
CONCLUSION
Our analysis failed to show efficacy of ivabradine in mitigating anthracycline-induced cardiotoxicity. small sample size and heterogeneity limits definitive interpretation, warranting a large-scale RCT with longer follow-up period.
Core Tip: Anthracyclines-induced chemotherapy is associated with a risk of cardiotoxicity, often manifesting as reductions in left ventricular ejection fraction and subclinical myocardial injury. In this meta-analysis of randomized studies, ivabradine did not demonstrate a significant effect in preserving left ventricular ejection fraction or improving cardiac biomarkers, including troponin and NT-proBNP, nor did it significantly reduce global longitudinal strain deterioration. These findings suggest that while ivabradine is well tolerated and does not adversely affect blood pressure, current evidence does not support its routine use for the prevention of anthracycline-induced cardiotoxicity. Larger randomized trials are needed to clarify its potential cardioprotective role.
