Anthracyclines-Induced Vascular Endothelial Dysfunction in Cancer Patients and Survivors Using Brachial Flow-Mediated Dilation (FMD) Tool: A Systematic Review and Meta-Analysis
<p dir="ltr">Anthracyclines are effective antineoplastic drugs; however, their use is constrained by dose-dependent cardiotoxicity. Vascular endothelial dysfunction is an early independent event in cardiovascular diseases and may precede anthracycline-induced cardiotoxicity. Brachial...
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2025
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| _version_ | 1864513534656774144 |
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| author | Lana A. Kattan (22466173) |
| author2 | Sara M. Abulola (14724830) Mohamed Izham Mohamed Ibrahim (14158896) Zaid H. Maayah (9236533) |
| author2_role | author author author |
| author_facet | Lana A. Kattan (22466173) Sara M. Abulola (14724830) Mohamed Izham Mohamed Ibrahim (14158896) Zaid H. Maayah (9236533) |
| author_role | author |
| dc.creator.none.fl_str_mv | Lana A. Kattan (22466173) Sara M. Abulola (14724830) Mohamed Izham Mohamed Ibrahim (14158896) Zaid H. Maayah (9236533) |
| dc.date.none.fl_str_mv | 2025-04-03T03:00:00Z |
| dc.identifier.none.fl_str_mv | 10.1007/s12012-025-09986-2 |
| dc.relation.none.fl_str_mv | https://figshare.com/articles/journal_contribution/Anthracyclines-Induced_Vascular_Endothelial_Dysfunction_in_Cancer_Patients_and_Survivors_Using_Brachial_Flow-Mediated_Dilation_FMD_Tool_A_Systematic_Review_and_Meta-Analysis/30405280 |
| dc.rights.none.fl_str_mv | CC BY 4.0 info:eu-repo/semantics/openAccess |
| dc.subject.none.fl_str_mv | Biomedical and clinical sciences Cardiovascular medicine and haematology Oncology and carcinogenesis Paediatrics Anthracycline Endothelial dysfunction Flow-mediated dilation (FMD) Childhood cancers |
| dc.title.none.fl_str_mv | Anthracyclines-Induced Vascular Endothelial Dysfunction in Cancer Patients and Survivors Using Brachial Flow-Mediated Dilation (FMD) Tool: A Systematic Review and Meta-Analysis |
| dc.type.none.fl_str_mv | Text Journal contribution info:eu-repo/semantics/publishedVersion text contribution to journal |
| description | <p dir="ltr">Anthracyclines are effective antineoplastic drugs; however, their use is constrained by dose-dependent cardiotoxicity. Vascular endothelial dysfunction is an early independent event in cardiovascular diseases and may precede anthracycline-induced cardiotoxicity. Brachial flow-mediated dilation (FMD) is a non-invasive technique for evaluating vascular endothelial function. We evaluated the evidence on anthracycline-induced vascular endothelial dysfunction in cancer patients and survivors using FMD. Studies measuring FMD in anthracycline-treated active cancer patients or survivors were retrieved from inception to August 2024 using PubMed, Embase, and Scopus. The primary outcome was the difference in FMD between anthracycline-treated patients and healthy controls or baseline. We performed the meta-analysis using a random-effects model and evaluated the certainty in effect estimates. Overall, 18 studies (n = 841 patients) met the inclusion criteria. Compared to the baseline, a non-significant change toward a decline in FMD was observed. However, a significant reduction in FMD was observed in anthracycline-treated patients compared to healthy controls (standardized mean difference (SMD): − 0.6082; 95% CI: − 0.8963 to − 0.3201; p < 0.0001). Subgroup analyses revealed consistent significant reductions in FMD for childhood cancers (SMD: − 0.7189; 95% CI: − 0.9903 to − 0.4476; p < 0.0001), while adult cancers showed no significant difference. No significant publication bias was detected overall for healthy control comparisons. High heterogeneity was observed in the included studies (<i>I</i><sup><em>2</em></sup> = 81.7808% versus healthy controls and <i>I</i><sup><em>2</em></sup> = 75.6876% for childhood cancers subgroup analysis). Anthracyclines induce vascular endothelial dysfunction, indicated by lower FMD in cancer patients and survivors, particularly among those with childhood cancers, who might be at risk of long-term cardiovascular complications.</p><h2>Other Information</h2><p dir="ltr">Published in: Cardiovascular Toxicology<br>License: <a href="https://creativecommons.org/licenses/by/4.0" target="_blank">https://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1007/s12012-025-09986-2" target="_blank">https://dx.doi.org/10.1007/s12012-025-09986-2</a></p> |
| eu_rights_str_mv | openAccess |
| id | Manara2_e3667d7aaeb9cacbca17c9a26229f851 |
| identifier_str_mv | 10.1007/s12012-025-09986-2 |
| network_acronym_str | Manara2 |
| network_name_str | Manara2 |
| oai_identifier_str | oai:figshare.com:article/30405280 |
| publishDate | 2025 |
| repository.mail.fl_str_mv | |
| repository.name.fl_str_mv | |
| repository_id_str | |
| rights_invalid_str_mv | CC BY 4.0 |
| spelling | Anthracyclines-Induced Vascular Endothelial Dysfunction in Cancer Patients and Survivors Using Brachial Flow-Mediated Dilation (FMD) Tool: A Systematic Review and Meta-AnalysisLana A. Kattan (22466173)Sara M. Abulola (14724830)Mohamed Izham Mohamed Ibrahim (14158896)Zaid H. Maayah (9236533)Biomedical and clinical sciencesCardiovascular medicine and haematologyOncology and carcinogenesisPaediatricsAnthracyclineEndothelial dysfunctionFlow-mediated dilation (FMD)Childhood cancers<p dir="ltr">Anthracyclines are effective antineoplastic drugs; however, their use is constrained by dose-dependent cardiotoxicity. Vascular endothelial dysfunction is an early independent event in cardiovascular diseases and may precede anthracycline-induced cardiotoxicity. Brachial flow-mediated dilation (FMD) is a non-invasive technique for evaluating vascular endothelial function. We evaluated the evidence on anthracycline-induced vascular endothelial dysfunction in cancer patients and survivors using FMD. Studies measuring FMD in anthracycline-treated active cancer patients or survivors were retrieved from inception to August 2024 using PubMed, Embase, and Scopus. The primary outcome was the difference in FMD between anthracycline-treated patients and healthy controls or baseline. We performed the meta-analysis using a random-effects model and evaluated the certainty in effect estimates. Overall, 18 studies (n = 841 patients) met the inclusion criteria. Compared to the baseline, a non-significant change toward a decline in FMD was observed. However, a significant reduction in FMD was observed in anthracycline-treated patients compared to healthy controls (standardized mean difference (SMD): − 0.6082; 95% CI: − 0.8963 to − 0.3201; p < 0.0001). Subgroup analyses revealed consistent significant reductions in FMD for childhood cancers (SMD: − 0.7189; 95% CI: − 0.9903 to − 0.4476; p < 0.0001), while adult cancers showed no significant difference. No significant publication bias was detected overall for healthy control comparisons. High heterogeneity was observed in the included studies (<i>I</i><sup><em>2</em></sup> = 81.7808% versus healthy controls and <i>I</i><sup><em>2</em></sup> = 75.6876% for childhood cancers subgroup analysis). Anthracyclines induce vascular endothelial dysfunction, indicated by lower FMD in cancer patients and survivors, particularly among those with childhood cancers, who might be at risk of long-term cardiovascular complications.</p><h2>Other Information</h2><p dir="ltr">Published in: Cardiovascular Toxicology<br>License: <a href="https://creativecommons.org/licenses/by/4.0" target="_blank">https://creativecommons.org/licenses/by/4.0</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1007/s12012-025-09986-2" target="_blank">https://dx.doi.org/10.1007/s12012-025-09986-2</a></p>2025-04-03T03:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1007/s12012-025-09986-2https://figshare.com/articles/journal_contribution/Anthracyclines-Induced_Vascular_Endothelial_Dysfunction_in_Cancer_Patients_and_Survivors_Using_Brachial_Flow-Mediated_Dilation_FMD_Tool_A_Systematic_Review_and_Meta-Analysis/30405280CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/304052802025-04-03T03:00:00Z |
| spellingShingle | Anthracyclines-Induced Vascular Endothelial Dysfunction in Cancer Patients and Survivors Using Brachial Flow-Mediated Dilation (FMD) Tool: A Systematic Review and Meta-Analysis Lana A. Kattan (22466173) Biomedical and clinical sciences Cardiovascular medicine and haematology Oncology and carcinogenesis Paediatrics Anthracycline Endothelial dysfunction Flow-mediated dilation (FMD) Childhood cancers |
| status_str | publishedVersion |
| title | Anthracyclines-Induced Vascular Endothelial Dysfunction in Cancer Patients and Survivors Using Brachial Flow-Mediated Dilation (FMD) Tool: A Systematic Review and Meta-Analysis |
| title_full | Anthracyclines-Induced Vascular Endothelial Dysfunction in Cancer Patients and Survivors Using Brachial Flow-Mediated Dilation (FMD) Tool: A Systematic Review and Meta-Analysis |
| title_fullStr | Anthracyclines-Induced Vascular Endothelial Dysfunction in Cancer Patients and Survivors Using Brachial Flow-Mediated Dilation (FMD) Tool: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Anthracyclines-Induced Vascular Endothelial Dysfunction in Cancer Patients and Survivors Using Brachial Flow-Mediated Dilation (FMD) Tool: A Systematic Review and Meta-Analysis |
| title_short | Anthracyclines-Induced Vascular Endothelial Dysfunction in Cancer Patients and Survivors Using Brachial Flow-Mediated Dilation (FMD) Tool: A Systematic Review and Meta-Analysis |
| title_sort | Anthracyclines-Induced Vascular Endothelial Dysfunction in Cancer Patients and Survivors Using Brachial Flow-Mediated Dilation (FMD) Tool: A Systematic Review and Meta-Analysis |
| topic | Biomedical and clinical sciences Cardiovascular medicine and haematology Oncology and carcinogenesis Paediatrics Anthracycline Endothelial dysfunction Flow-mediated dilation (FMD) Childhood cancers |