OVERCOME

PreventiOn of left Ventricular dysfunction with Enalapril and caRvedilol in patients submitted to intensive ChemOtherapy for the treatment of Malignant hEmopathies

Patient / Population Intervention / Exposition Vergleich Endpunkt

In 90 patients with malignant haemopathies undergoing intensive chemotherapy or autologous stem-cell transplantation, enalapril plus carvedilol started before chemotherapy preserved left ventricular ejection fraction and reduced death or heart failure at 6 months compared with no cardioprotective treatment.

N
90
Design
Randomised controlled trial with an untreated control group
Endpunkt
Absolute change in left ventricular ejection fraction at 6 months
Relevanz
3
ErgebnisLVEF unchanged with treatment but reduced in controls (between-group difference −3.1 %; p=0.035). Death or heart failure 6.7 % vs 22 % (p=0.036).
Bosch X, Rovira M, Sitges M, et al. J Am Coll Cardiol. 2013;61(23):2355-2362. 10.1016/j.jacc.2013.02.072
Diskussion & Kritik

Very small, single-centre, with an untreated rather than placebo control and a composite built on few events, so the clinical benefit is fragile. It is the only randomised cardioprotection trial to reduce a clinical composite of death or heart failure and is the strongest pillar of combined ACE-inhibitor plus beta-blocker prophylaxis.