ACE Inhibitors in the Therapy of Ventricular Dysfunction after Cardiotoxic Cytostatics

Overview

Morbidity and mortality resulting from cardiotoxic complications of anticancer therapy is stillunacceptably high. Despite advances in the understanding of the pathomechanisms of cardiotoxicity,in prevention and detection of these complications, progressive ventricular dysfunction in cancersurvivors represents a great therapeutic problem. Ventricular dysfunction is a life-threateningcomplication particularly in patients treated with anthracycline cytostatics. Anthracycline-inducedloss of myocytes leads to an inadequate ventricular hypertrophy, which produces a rise in leftventricular (LV) afterload and deterioration of ventricular contractility culminating in heart failure.Efficacy of angiotensin-converting enzyme (ACE) inhibitors for the treatment of asymptomatic andsymptomatic LV dysfunction in various clinical settings has been confirmed in a number ofcontrolled, randomized trials. Until now, there are only few published data supporting the use ofACE inhibitors to treat patients with ventricular dysfunction-induced by anthracyclines. Cardioprotectionwith ACE inhibitors in children and adolescents treated with anthracyclines in contrastto ACE inhibition in adults after anthracycline therapy is a controversial topic. Evidence from therecent follow up study indicates a progressive deterioration of left ventricular wall thinning inchildhood cancer survivors treated with enalapril. The ongoing large controlled, double blind,randomized trials will provide an important information concerning the efficacy of ACE inhibitorsto prevent progression of ventricular dysfunction in paediatric oncologic patients.

Key words:
anthracyclines – late cardiotoxicity – ventricular dysfunction – heart failure –ACE inhibitors