Meta-Analysis Links Heart Failure Therapies to Better Cardiac Function During Cancer Treatment

Key Takeaways

• RAAS inhibition plus beta blockers was associated with the largest reported LVEF gain among the more commonly studied therapies.
• RAAS inhibitors, beta blockers, and their combination were also associated with improved global longitudinal strain, while statins were associated with improved LVEF.

In pooled data from patients receiving anticancer drugs, combined RAAS inhibition and beta blockers was associated with a 2.98% improvement in left ventricular ejection fraction across eight studies, the largest gain among the more commonly studied therapies. The 19 Jun, 2026 ESC Cardio-Oncology 2026 press release summarized a Vienna presentation of a meta-analysis of 49 studies involving 6,998 patients. 

The analysis pooled published studies in patients treated with anticancer drugs, including randomized controlled trials and retrospective and prospective non-randomized studies. Therapies evaluated were those recommended in the 2021 ESC heart failure guidelines and the 2023 update, alongside statins. The classes assessed were RAAS inhibitors, beta blockers, mineralocorticoid receptor antagonists, SGLT2 inhibitors, and statins, within an evidence base the presenter described as limited and often small. 

Across the more established therapy classes, RAAS inhibition improved LVEF by 2.88% versus placebo/standard of care across 23 studies (p<0.001). Beta blockers improved LVEF by 1.20% versus placebo/standard of care across 22 studies (p=0.05), a more modest pooled change. Statins were evaluated in seven studies and showed an LVEF increase of 2.49% versus controls (p<0.001). Global longitudinal strain also improved with RAAS inhibitors, beta blockers, and the combination of both therapies, although no pooled strain numbers were reported. 

Mineralocorticoid receptor antagonists were associated with a 4.68% increase in LVEF, but that estimate came from only two studies. SGLT2 inhibition showed a 3.20% improvement in LVEF in one study, leaving very limited direct evidence for that class.