Effect of Enalapril on Preventing Anthracycline-Induced Cardiomyopathy

Abstract

Anthracycline (ANT) is a topoisomerase-interacting agent that is used in most malignancy treatments. We investigated the efficacy of enalapril (angiotensin-converting enzyme inhibitor) in the prevention of ANT-induced cardiomyopathy. In this randomized, single-blind, and placebo-controlled study, 69 patients with a newly diagnosed malignancy for which ANT therapy was planned were randomly assigned to either a group receiving enalapril (n=34) or placebo (n=35). Echocardiography studies were performed before chemotherapy and at 6months after randomization. Additionally, troponin I and creatinine kinase-MB (CK-MB) were measured 1month after the initiation of chemotherapy. In the enalapril group, the mean left ventricular ejection fraction (LVEF) (p=0.58) was the same at baseline and 6months after randomization. Conversely, LVEF significantly decreased in the control group (p<0.001). Additionally, LV end systolic volume and left atrial diameter were significantly increased compared with the baseline measures in the control group. According to the tissue Doppler study, the mitral annuli early diastolic (e') and peak systolic (s') velocities were significantly reduced, and the E (the peak early diastolic velocity)/e' ratio was significantly increased in the control group. Furthermore, the TnI and CK-MB levels were significantly higher in the control group than in the enalapril group. Enalapril appears efficacious in preserving systolic and diastolic function in cancer patients treated with ANTs.