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Cardio-oncology & otherRandomised controlled trial

Multicenter, Prospective, Randomized Controlled Trial of High-Sensitivity Cardiac Troponin I–Guided Combination Angiotensin Receptor Blockade and Beta-Blocker Therapy to Prevent Anthracycline Cardiotoxicity: The Cardiac CARE Trial

CirculationPublished

  • Randomised controlled trial
  • multicentre
  • prospective
  • open-label
  • blinded end-point
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Authors' conclusion

Combination candesartan and carvedilol therapy had no demonstrable cardioprotective effect in patients receiving anthracycline-based chemotherapy with high-risk on-treatment cardiac troponin I concentrations. Low-risk nonrandomized patients had similar declines in left ventricular ejection fraction, bringing into question the utility of routine cardiac troponin monitoring.

Study context

Population
Patients with breast cancer or non-Hodgkin lymphoma receiving anthracycline chemotherapy at high risk of cardiotoxicity (cardiac troponin I in the upper tertile during chemotherapy)recruited
Participants
175 patients
Comparison
Cardioprotection vs Standard care
  • Cardioprotectionn = 29
  • Standard caren = 28reference
Primary endpoint
Adjusted change in LVEF
Follow-up
6 months

Primary result

LVEF at 6 months · 6 months after completion of chemotherapy

Estimated mean difference

−0.37 %

95% CI −3.59% to 2.85%

P = 0.82

By group

Cardioprotection vs Standard care
estimated mean difference −0.37 % (95% CI −3.59% to 2.85%); P = 0.82

As reported in the abstract

Further findings

OutcomeValuesestimated mean difference (%) (95% CI)P value
LVEF in low-risk nonrandomized patients (troponin I in lower 2 tertiles); equivalence ±2% · 6 months · not equivalentLow-risk nonrandomized mean 66.4 (SD 6.3) % · Baseline LVEF 69.3±5.7%2.87 (1.63%–4.10%)P = 0.92
  • LVEF in low-risk nonrandomized patients (troponin I in lower 2 tertiles); equivalence ±2%: equivalence margin ±2%; not equivalent

Original publication

Multicenter, Prospective, Randomized Controlled Trial of High-Sensitivity Cardiac Troponin I–Guided Combination Angiotensin Receptor Blockade and Beta-Blocker Therapy to Prevent Anthracycline Cardiotoxicity: The Cardiac CARE Trial. Circulation. Published 25 September 2023. doi:10.1161/circulationaha.123.064274
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Summarised from the published abstract; every number is checked against it