Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 5 appraisals
The American journal of cardiology
Sacubitril/Valsartan and Prevention of Chemotherapy-Induced Cardiac Dysfunction: Meta-analysis of Randomized Trials
Chemotherapy-related cardiac dysfunction (CTRCD) is a major limitation of cardiotoxic cancer therapies. Although global longitudinal strain (GLS) allows early detection of myocardial injury, preventive strategies remain scarce. Angiotensin receptor-neprilysin inhibitors (ARNIs) may offer cardioprotection, but current evidence is limited. We conducted a systematic review and meta-analysis of randomized controlled trials evaluating Sacubitril/Valsartan versus control in patients undergoing chemotherapy. PubMed, Embase, and Cochrane databases were searched. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were computed for binary and continuous outcomes. Four randomized controlled trials comprising 412 participants were included; 42.7% received ARNI therapy, with follow-up ranging from 6 to 18 months. Compared with control, ARNI significantly preserved left ventricular systolic function (MD 1.47%, 95% CI 0.59-2.34) and attenuated GLS deterioration (MD -0.93%, 95% CI -1.49 to -0.38). However, ARNI did not significantly reduce the incidence of CTRCD (RR 0.40, 95% CI 0.08-1.97) or all-cause mortality (RR 0.63, 95% CI 0.08-5.01). ARNI increased the risk of hypotension but had no significant effects on NT-proBNP or dyspnea. In conclusion, ARNI therapy improves GLS and left ventricular ejection fraction during chemotherapy but has not yet demonstrated reductions in CTRCD or mortality. Hypotension remains a key safety consideration.
16 June 2026
Read appraisal →European heart journal
Digital profile of children's hearts: automated echocardiogram strain analysis facilitates earlier detection of cardiac dysfunction
BACKGROUND AND AIMS: Paediatric myocardial strain analysis through echocardiography is often characterized by high variance and limited precision, highlighting the need for a standardized and vendor-agnostic approach applicable for diverse image qualities and populations, which could enhance cardiac function evaluation and enable early detection of cardiac impairment. METHODS: The Motion-Echo system was proposed, a semi-supervised deep learning framework built on 11 096 paediatric and 11 297 adult echocardiograms spanning diverse image qualities and vendors. It integrated context compensation and motion estimation modules for temporally coherent segmentation, myocardial motion estimation, and global strain assessment with minimal manual annotations. Clinical utility was further evaluated through downstream applications. RESULTS: Motion-Echo achieved mean absolute errors of 2.099% [95% confidence interval (CI) 1.803-2.401] and 2.665% (95% CI 2.339-3.026) for global longitudinal and circumferential strain assessments, with Pearson correlation coefficients of 0.799 (95% CI 0.715-0.871) and 0.781 (95% CI 0.687-0.844), respectively. To validate the clinical utility, automated strain values achieved an area under the curve (AUC) of 0.906 (95% CI 0.816-0.981) for cancer therapy-related cardiac dysfunction risk prediction. For late gadolinium enhancement detection, automated global longitudinal strain reached an AUC of 0.782 (95% CI 0.666-0.885). For left ventricular ejection fraction decline forecasting, the system outperformed manual strain values (DeLong P < .001). In addition, incorporating estimated motion flows yielded a remarkable AUC improvement to 0.952 (95% CI 0.917-0.980) for myocardial infarction detection. CONCLUSIONS: Leveraging a large-scale paediatric dataset, Motion-Echo provided a reliable and generalizable framework for myocardial strain analysis, demonstrating potential to facilitate earlier detection of cardiac dysfunction and generate digital cardiac function profiles of children.
16 May 2026
Read appraisal →PloS one
An exploratory dosimetric and treatment-time analysis of tangent-arc and continuous semi-arc VMAT in deep inspiration breath-hold radiotherapy for stage I left-sided breast cancer
BACKGROUND: The use of the deep inspiration breath-hold (DIBH) technique reduces cardiac and lung radiation exposure during left breast cancer radiotherapy. However, the optimal beam delivery technique and the effects of patient adaptation during DIBH remain incompletely understood. OBJECTIVE: In this study, the dosimetric differences between continuous semi-arc and tangent-arc plans in stage I left-sided breast cancer patients using DIBH were compared, and the treatment session duration was descriptively analyzed to characterize treatment-time trends during routine DIBH delivery. METHODS: Twenty patients treated at our hospital from 01/05/2022-31/05/2023 were retrospectively selected from the institutional database for exploratory dosimetric analysis. Two radiotherapy plans were created on the basis of each patient's computed tomography (CT) images. Dosimetric parameters for the planning target volume (PTV) and organs at risk (OARs), and beam-on and total treatment times, were compared. RESULTS: The conformity index (CI) for the PTV was significantly better with the continuous semi-arc plan (P < 0.05), whereas the other PTV parameters did not significantly differ between the plans (P > 0.05). The doses and beam-on time for all OARs (except the left ventricle) were significantly lower for the tangent-arc plan (P < 0.05). Treatment time tended to stabilize across fractions, with a significant difference between the 15th and 16th sessions (P < 0.05). CONCLUSION: With the tangent-arc plan, the beam-on time and radiation exposure to OARs were observed to be lower, while adequate PTV coverage was maintained in patients with stage I left-sided breast cancer using DIBH. Treatment times tended to stabilize with increasing treatment fractions. This observation suggests gradual patient adaptation during routine DIBH rather than a predefined training effect. Given the exploratory nature of these findings and the limited sample size from a single institution, these findings should be interpreted with caution and warrant further investigation in larger, multicenter studies.
11 May 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Cardiac adverse events associated with axitinib: A real-world pharmacovigilance study based on the Japanese adverse drug event report database
OBJECTIVE: To evaluate the disproportionality, times to onset, and outcomes of cardiac adverse events (AEs) associated with axitinib, using data from the Japanese Adverse Drug Event Report (JADER) database. METHODS: We analyzed data for the period from April 2004 to December 2024. Those on cardiac AEs were extracted and the disproportionality of axitinib-associated AEs was assessed by calculating reporting odds ratios (RORs). RESULTS: Of the 2,988,681 reports with sex and age information, we identified 4788 reports of AEs associated with axitinib, including 508 cardiac AEs. Signals were detected for 16 cardiac AEs after adjustment for sex and age. Fatal outcomes were reported for five of these events with particularly high rates observed for cardiac failure, myocarditis, and immune-mediated myocarditis. Median times to onset indicated that cardiac AEs associated with axitinib occurred 14 to 420 days after administration. Weibull distributions showed that seven AEs (blood pressure increased, myocardial infarction, acute myocardial infarction, blood pressure systolic increased, oedema peripheral, oedema, and generalised oedema) occurred constantly throughout the exposure period (random failure type), and stress cardiomyopathy and immune-mediated myocarditis developed in a dose-dependent manner (wear-out failure-type). CONCLUSIONS: We focused on cardiac AEs associated with axitinib as post-marketing AEs. Some with fatal outcomes may occur not only early in treatment but also later in the course. Continuous monitoring is essential to ensure timely detection and management of these potentially serious AEs in clinical practice.
28 Apr 2026
Read appraisal →European heart journal
Venous thromboembolism and bleeding in cancer patients: role of inflammatory and cardiac biomarkers.
BACKGROUND AND AIMS: Patients with cancer have increased risk of venous thromboembolism (VTE) and bleeding. Inflammatory and cardiac biomarkers may predict these complications, but their role remains unclear. This study examined associations between two inflammatory-related markers (C-reactive protein and growth differentiation factor-15) and two cardiac markers [N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin T (hs-TnT)] with VTE and clinically relevant bleeding in cancer patients. METHODS: A post hoc analysis of the AVERT trial, which evaluated apixaban for VTE prevention in ambulatory cancer patients with a Khorana score of ≥2, was performed. Biomarkers were measured at baseline and 1 month, with C-reactive protein also at 3 months. Fine and Gray regression, accounting for competing risk of death and adjusted for age and advanced cancer, estimated subdistribution hazard ratios (SHRs) for VTE and clinically relevant bleeding. RESULTS: Of 574 patients, 514 provided baseline samples. One- and 3-month samples were available from 454 and 447, and 378 and 364, patients without prior VTE and bleeding events, respectively. Elevated baseline growth differentiation factor-15 was associated with increased VTE risk [SHR 1.36, 95% confidence interval (CI) 1.01-1.84]. N-terminal pro-B-type natriuretic peptide (SHR 1.44, 95% CI 1.08-1.92) and C-reactive protein (SHR 1.38, 95% CI 1.07-1.76) were linked to bleeding risk. Increasing high-sensitivity troponin T from baseline to 1 month was associated with higher VTE risk (SHR 1.89, 95% CI 1.14-3.16). Nomograms were developed to estimate VTE and clinically relevant bleeding risks. CONCLUSIONS: Select inflammatory-related and cardiac markers were associated with VTE and bleeding risks in cancer patients, which can be determined using developed nomograms. Prospective research is needed to confirm these findings.
23 Apr 2026
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