{
  "abstract": "Background\n\nCancer therapy related cardiac dysfunction (CTRCD) is a major concern in breast cancer patients, often reducing left ventricular ejection fraction (LVEF) and causing symptomatic heart failure. This study assessed the comparative effectiveness and safety of cardioprotective drugs in preserving LVEF during chemotherapy.Methods\n\nOur database search, included Cochrane, PubMed, WOS, and SCOPUS, from inception to May 1st, 2024, to find randomized controlled trials (RCTs) that assessed the effectiveness and safety of cardioprotective drugs in breast cancer patients undergoing chemotherapy. Bayesian network meta-analysis and meta-regression were performed using the BUGSnet package in R studio version 4.4.2, applying a random-effects model, and mean differences (MD) with 95% credible intervals (CrI) were calculated.Results\n\nEighteen RCTs involving 2,223 patients, met the inclusion criteria. Participants had a mean age was 48.78 (SD: 9.7). Spironolactone provided the greatest improvement in LVEF compared to placebo MD: 12.80; 95% CrI: 5.99 to 19.60, with the highest SUCRA value (97.84). Nebivolol ranked second (MD: 7.30; 95% CrI: 0.34 to 14.25; SUCRA: 81.67), while lisinopril + bisoprolol showed modest benefit (MD: 5.25; 95% CrI: -1.57 to 12.06; SUCRA: 69.43). Other agents, including rosuvastatin, bisoprolol, and candesartan, had variable effects with wide CrIs, and carvedilol and metoprolol showed limited efficacy. Model diagnostics confirmed stable convergence, good model fit, and no significant inconsistency across comparisons. Covariate-adjusted effect size from Bayesian network meta-regression identified hypertension prevalence and sample size as significant positive modifiers of treatment effect. Sensitivity analyses using a leave-one-out approach confirmed the robustness of the findings.Conclusion\n\nSpironolactone and nebivolol are promising candidates for preserving LVEF in breast cancer patients undergoing cardiotoxic chemotherapy, while metoprolol showed minimal benefit. However, further studies with larger sample sizes and longer follow-up are essential to validate these results and assess long-term clinical outcomes.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Internal Medicine, College of Medicine, University of Baghdad, Baghdad, Iraq.",
    "Department of Internal Medicine, Faculty of Medicine, University of Alexandria, Alexandria, Egypt.",
    "Department of Internal Medicine, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh.",
    "Department of Internal Medicine, Peoples University of Medical and Health Sciences for Women, Nawabshah, Pakistan.",
    "Department of Internal Medicine, Allama Iqbal Medical College, Lahore, Pakistan.",
    "Department of Internal Medicine, University of Tripoli Faculty of Medicine, Tripoli, Libya.",
    "Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.",
    "Department of Internal Medicine, Maritime Hospital, Byblos, Lebanon.",
    "Department of Internal Medicine, Mamata Medical College, Khammam, India.",
    "Department of Cardiology, Camden Clark Medical Center, West Virginia University, Parkersburg, WV, USA.",
    "Department of Internal Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt.",
    "Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA.",
    "Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA.",
    "Division of Cardiology, University of Texas Medical Branch, Galveston, TX, USA. wikhalif@utmb.edu.",
    "Division of Cardiology, University of Texas Medical Branch, 301 University Blvd. 5.106 John Sealy Annex, Galveston, TX, 77555-0553, USA. wikhalif@utmb.edu."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 18,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Ali Saad Al-Shammari"
    },
    {
      "affs": [
        1
      ],
      "name": "Ahmed Ibrahim"
    },
    {
      "affs": [
        2
      ],
      "name": "M Rafiqul Islam"
    },
    {
      "affs": [
        0
      ],
      "name": "Ahmed Sermed Al Sakini"
    },
    {
      "affs": [
        3
      ],
      "name": "Pakeezah Tabasum"
    },
    {
      "affs": [
        4
      ],
      "name": "Rubab Zahra"
    },
    {
      "affs": [
        5
      ],
      "name": "Naiela E Almansouri"
    },
    {
      "affs": [
        6
      ],
      "name": "Hadeel Aboueisha"
    },
    {
      "affs": [
        7
      ],
      "name": "Hiba Hamdar"
    },
    {
      "affs": [
        4
      ],
      "name": "Uzair Iqbal"
    },
    {
      "affs": [
        8
      ],
      "name": "Shanmukh Lingamsetty"
    },
    {
      "affs": [
        9
      ],
      "name": "Yasar Sattar"
    },
    {
      "affs": [
        10
      ],
      "name": "Mohamed Abuelazm"
    },
    {
      "affs": [
        11
      ],
      "name": "Mohanad Albayyaa"
    },
    {
      "affs": [
        11
      ],
      "name": "Abdelrahman Ali"
    },
    {
      "affs": [
        12
      ],
      "name": "Cezar Iliescu"
    },
    {
      "affs": [
        11
      ],
      "name": "Haider Al-Taii"
    },
    {
      "affs": [
        13,
        14
      ],
      "name": "Wissam Khalife"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5jfk4tzw9n0d3.bib",
  "cited_by": 0,
  "doi": "10.1186/s40959-026-00515-w",
  "fulltext_url": "https://europepmc.org/articles/PMC13721243",
  "id": "5jfk4tzw9n0d3",
  "issns": [
    "2057-3804"
  ],
  "landing_url": "https://europepmc.org/article/MED/42958440",
  "language": "eng",
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "2705|Chemotherapy-induced cardiotoxicity and mitigation"
    ]
  ],
  "openalex": "W7172340152",
  "pdf_url": "https://europepmc.org/articles/PMC13721243?pdf=render",
  "pmcid": "PMC13721243",
  "pmid": "42958440",
  "published": "2026-08-03",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/5jfk4tzw9n0d3.ris",
  "sources": [
    {
      "first_seen": "2026-11-01T00:20:47Z",
      "native_id": "MED:42958440",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42958440"
    },
    {
      "first_seen": "2026-11-03T12:21:58Z",
      "native_id": "PMC13721243",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s40959-026-00515-w"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Chemotherapy-induced cardiotoxicity and mitigation",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Pharmacologic prevention of cardiotoxicity in breast cancer: a Bayesian network meta-analysis and meta-regression.",
  "title_text": "Pharmacologic prevention of cardiotoxicity in breast cancer: a Bayesian network meta-analysis and meta-regression.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-03T12:21:58Z",
  "url": "https://research.draconitic.com/paper/5jfk4tzw9n0d3",
  "venue": "Cardio-oncology (London, England)",
  "versions": []
}