Potential role of angiotensin-converting enzyme inhibitors vs beta-blockers in preventing anticancer agents-induced cardiotoxicity: A systematic review and meta-analysis

Figure 1 PRISMA flow diagram representing breakdown of screened and included studies. ¹Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). ²If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools. This work is licensed under CC BY 4.0. To view a copy of this license, visit https://creativecommons.org/Licenses/by/4.0/. Citation: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021; 372: N71. Copyright ©The Author(s) 2021. Published by BMJ Publishing Group Ltd[35]. PICO: Population, intervention, control and outcome.

Figure 2 Risk of bias assessment of included randomized controlled trials.

Figure 3 Forest plot comparing angiotensin-converting enzymes inhibitors and beta-blockers for left ventricular ejection fraction change and total cardiotoxicity events. A: Change in left ventricular ejection fraction; B: Total cardiotoxicity events. ACE: Angiotesin converting enzymes; BB: Beta blockers; ACEI: Angiotensin-converting enzymes inhibitors; CI: Confidence interval.

Figure 4 Forest plot of echocardiographic parameters comparing angiotensin-converting enzymes inhibitors and beta-blockers. A: Change in E/E’; B: Change in E/A; C: Change in left ventricular end diastolic diameter; D: Change in left ventricular end systolic diameter. ACE: Angiotesin converting enzymes; BB: Beta blockers; ACEI: Angiotensin-converting enzymes inhibitors; CI: Confidence interval.

Figure 5 Forest plot comparing angiotensin-converting enzymes inhibitors and beta-blockers for early and late cardiotoxicity events. A: Early cardiotoxicity events; B: Late cardiotoxicity events. ACE: Angiotesin converting enzymes; BB: Beta blockers; ACEI: Angiotensin-converting enzymes inhibitors; CI: Confidence interval.

Figure 6 Forest plot comparing angiotensin-converting enzymes inhibitors and beta-blockers for total adverse events, palpitations, hypotension, and dizziness. A: Total adverse events; B: Palpitations; C: Hypotension; D: Dizziness. BB: Beta blockers; ACEI: Angiotensin-converting enzymes inhibitors; CI: Confidence interval.