The efficacy of carvedilol in improving cardiac function and survival in patients with anthracycline-induced cardiotoxicity: a comprehensive systematic review and meta-analysis

Anthracyclines (ANT) are widely used in chemotherapy, but their dose-dependent Cardiotoxicity limits long-term use. Carvedilol, a non-selective beta-blocker, has shown potential as a Cardioprotective agent for patients receiving ANT, though its overall effectiveness remains unclear. This systematic review and meta -analysis aimed to assess the impact of carvedilol on cardiac function and survival in patients with anthracycline-induced Cardiotoxicity. We performed a comprehensive search of major electronic databases through March 2025 for studies comparing carvedilol with placebo or no treatment in human subjects with ANT-Induced Cardiotoxicity. Primary outcomes included left ventricular ejection fraction (LVEF), left ventricular systolic dysfunction (LVSD), left ventricular systolic and diastolic diameters (LVsD, LVdD), and mortality. Secondary outcomes included echocardiographic and Doppler parameters. Random-effects models were used to calculate standard mean differences (SMDs) and risk ratios (RR) using RevMan 5.4. A total of fourteen studies were included, thirteen in the meta -analysis and one in the systematic review only, comprising 1,245 participants (carvedilol: 679; control: 566). Carvedilol significantly preserved LVEF (SMD: 0.33, 95% CI: 0.09, 0.58) and reduced the risk of LVSD (RR: 0.26, 95% CI: 0.11, 0.62). It also decreased systolic (SMD: −0.39, 95% CI: −0.53, −0.26) as well as diastolic ventricular diameter (SMD: −0.19, 95% CI: −0.38, −0.00). However, no significant difference in short-term mortality was observed. Carvedilol appears to protect cardiac function in patients undergoing ANT therapy, though it does not significantly impact mortality. Further research is needed to determine optimal dosing, timing, and long-term survival benefits.