Imtiaz, Zeeshan

e24182 Background: Cancer therapy-related cardiac dysfunction (CTRCD) is a clinically significant complication of anticancer treatments, including anthracyclines and trastuzumab, often necessitating dose reduction or discontinuation of potentially life-saving therapy. While angiotensin receptor-neprilysin inhibitors (ARNI) have demonstrated mortality and hospitalization benefits in heart failure with reduced ejection fraction, their efficacy in preventing chemotherapy-induced cardiotoxicity remains controversial due to conflicting results and a lack of large-scale data. Therefore, we performed a meta-analysis to evaluate the efficacy of ARNI for the prevention of cardiotoxicity in patients receiving chemotherapy. Methods: We searched PubMed, Embase, and Cochrane Central from intercept till 17 December 2025 for studies evaluating the benefit of ARNI in preventing CTRCD among patients undergoing cardiotoxic cancer therapy. The primary outcomes assessed were changes in left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), N-terminal pro-brain natriuretic peptide (NT-proBNP), and troponin T. Statistical analysis was performed using Review Manager, and heterogeneity was assessed using the I2 statistic. The study protocol was registered with PROSPERO (CRD420251266270). Results: A total of 442 patients from four RCTs were included, with follow-up periods ranging from 6 to 18 months. The analysis of changes in LVEF showed a trend toward improvement (mean difference 1.18; 95% CI -0.04 to 2.40; p = 0.06), though this did not reach statistical significance. There were no statistically significant differences observed in changes in GLS (mean difference -0.94; 95% CI -2.43 to 0.55; p = 0.14), NT-proBNP (mean difference -0.94; 95% CI -9.57 to 7.70; p = 0.69), or troponin T (mean difference 0.06; 95% CI -1.13 to 1.26; p = 0.92). Conclusions: In conclusion, prophylactic treatment with ARNI in patients undergoing cardiotoxic cancer therapy did not result in statistically significant changes in LVEF, GLS, or cardiac biomarkers (NT-proBNP and troponin T), although a non-significant trend toward preserved LVEF was observed. The lack of statistical significance may be attributable to limited statistical power due to small sample sizes and heterogeneity across cancer therapies. Given the observed trend in LVEF preservation, further adequately powered, large-scale RCTs focusing on specific chemotherapy regimens are needed.

Despite advances in percutaneous coronary procedures, in-stent restenosis remains a significant challenge. Although sirolimus- and paclitaxel-coated balloons are promising alternatives, their comparative safety and efficacy remain uncertain. PubMed, Embase, and Cochrane databases were searched using relevant keywords from inception until August 2025. A total of 11 studies (7 randomized controlled trials and 4 observational cohort studies) were included, comprising 3633 participants overall. The primary outcomes assessed were target lesion revascularization and target lesion failure. Meanwhile, the Secondary outcomes included stent thrombosis, all-cause mortality, myocardial infarction, major adverse cardiovascular events, survival, binary restenosis, and angiographic endpoints (acute gain, diameter stenosis, in-segment late lumen loss, in-lesion late lumen loss, and in-segment minimal lumen diameter). Interstudy heterogeneity was assessed using I ² and X ² statistics ( I ²>50% = significant heterogeneity). Interstudy heterogeneity was low for most outcomes, including all primary clinical endpoints, with moderate heterogeneity observed only for select angiographic measures (notably in-segment late lumen loss and diameter stenosis). Statistical analysis was conducted using R software and RStudio (version 4.4.2), with a P value of < 0.05 indicating statistical significance. This meta-analysis examined studies that compared paclitaxel-coated balloon (PCB) versus standard balloon [sirolimus-coated balloon (SCB)] angioplasty. Regarding primary outcomes, there were no notable variations in target lesion failure [risk ratio (RR), 1.08, 95% CI, 0.90–1.29, P = 0.36] or target lesion revascularization (RR, 1.16, 95% CI, 0.98–1.37, P = 0.08). With all aggregated estimates being nonsignificant, secondary outcomes such as stent thrombosis, all-cause mortality, myocardial infarction, major adverse cardiovascular events, and survival were similar between groups. Angiographic endpoints revealed no discernible variations in late lumen loss (in-lesion and in-segment), acute gain, or diameter stenosis. Nonetheless, the SCB group’s minimal lumen diameter was significantly smaller than that of the PCB group (MD, −0.08 mm, 95% CI, −0.14 to −0.01, P = 0.02). In treating coronary in-stent restenosis, SCB and PCBs show similar overall safety and effectiveness; lesion-specific angiographic variations indicate that customized selection may improve patient outcomes.

Managing persistent atrial fibrillation (AF) remains challenging due to its complex arrhythmic substrate, and pulmonary vein isolation through catheter ablation remains the primary treatment. This meta-analysis aims to compare the efficacy and safety outcomes of cryoballoon ablation (CBA) and radiofrequency ablation (RFA) in patients with persistent AF to provide evidence-based insights for clinical decision-making. A systematic search of PubMed, Embase, and Cochrane Central was conducted following PRISMA guidelines. Randomized controlled trials (RCTs) comparing CBA and RFA in persistent AF were included. Data on efficacy, safety, and procedural outcomes were pooled in the form of odds ratios (ORs) or mean differences (MDs) with corresponding 95% confidence intervals (CIs) using the random effects model in the Review Manager (RevMan) software. Four RCTs comprising 899 patients were included in our analysis. There were no significant differences between CBA and RFA in terms of AF recurrence, atrial tachycardia/flutter recurrence, or any arrhythmia recurrence during a mean follow-up period of 18 months after ablation. Procedure time was significantly shorter with CBA (MD: −44.85 minutes, 95% CI: −56.46 to −32.24, P < 0.01), while fluoroscopy time was comparable between the 2 groups (MD: 4.31 minutes, 95% CI: −1.79 to 10.40, P = 0.17). Safety outcomes, including overall complications, phrenic nerve palsy, access-site complications, and pericardial effusion, showed no significant differences between the 2 groups. CBA and RFA show similar rates of atrial arrhythmia recurrence and periprocedural complications in the treatment of persistent AF, while CBA offers the advantage of a shorter procedure time.