The severity of anthracycline-induced cardiotoxicity was widely varied, and no treatment option has been shown to be effective. In unselected patients, β-adrenergic receptor blockers and renin-angiotensin system inhibitor medications were associated with mild cardioprotective effects. The Cardiac CARE trial was a multicenter prospective randomized open-label blinded end-point trial of combination β-adrenergic receptor blocker and renin-angiotensin-system inhibitor counseling in patients with breast cancer and non-Hodgkin lymphoma obtaining anthracycline chemotherapy that was connected with myocardial injury. The trial was being conducted in patients who had been diagnosed with either breast cancer or non-Hodgkin lymph Patients who were at a higher risk of cardiotoxicity and whose plasma high-sensitivity cTnI (cardiac troponin I) concentrations were in the upper tertile at the end of chemotherapy were randomized to receive either standard of care plus combination candesartan and carvedilol therapy or standard of care alone. Before beginning treatment with an anthracycline, each patient had cardiac magnetic resonance imaging and then again 6 months later. The change in left ventricular ejection fraction 6 months after treatment was the major endpoint that would be measured. In low-risk nonrandomized patients, the left ventricular ejection fraction before and 6 months after anthracycline would be compared to determine the specificity of the high-sensitivity cTnI assay for recognizing low-risk participants who did not develop left ventricular systolic dysfunction. Cardiac CARE would investigate whether cardiac biomarker monitoring was able to identify patients who were at risk of left ventricular dysfunction as a result of anthracycline chemotherapy and whether troponin-guided treatment with combination candesartan and carvedilol therapy was able to prevent the development of left ventricular dysfunction in patients who were at high risk for it.

Source – ahajournals.org/doi/10.1161/CIRCHEARTFAILURE.121.009445