Meta-analysis finds improved heart function with CRT after cancer treatment

A systematic review and meta-analysis found that cardiac resynchronization therapy was associated with improved left-ventricular function and reduced ventricular volume in selected patients with cancer therapy–related cardiac dysfunction. The analysis pooled four observational studies involving 110 patients, most of whom were survivors of breast cancer or lymphoma or leukemia. The evidence suggests a structural and functional benefit from CRT in this population, but it does not establish effects on survival, hospitalization or other long-term clinical outcomes.

The studies assessed left-ventricular ejection fraction and left-ventricular volume, the two outcomes selected as the focus of the analysis. The investigators used a random-effects meta-analysis to combine the reported results and estimate 95% confidence intervals. Three studies were retrospective and one was prospective, so the pooled finding comes from a small body of observational evidence rather than a large controlled trial.

Across the four studies, 110 patients with cancer therapy–related cardiac dysfunction received CRT. Baseline left-ventricular ejection fraction ranged from 18.6% ± 7.6% to 28.5% ± 3.8%, with an overall mean of 24% ± 7%. After a mean follow-up of 9 ± 5 months, the meta-analysis estimated that left-ventricular ejection fraction increased by 9.95 percentage points, with a 95% confidence interval of 7.79–12.11.

End-systolic volume decreased by 39.17 milliliters, with a 95% confidence interval of 24.99–53.35 mL. These pooled results show improvement in the measured cardiac outcomes among the patients included in the selected studies. Three of the four studies also included control groups composed of patients with other forms of non-ischemic cardiomyopathy who also underwent CRT implantation.

In those comparisons, the improvement in left-ventricular ejection fraction did not differ significantly between the cancer-related group and the other non-ischemic cardiomyopathy group. The authors interpreted the magnitude of reverse remodeling observed in cancer therapy–related cardiac dysfunction as appearing similar to that seen in other non-ischemic causes of cardiac dysfunction. The finding of no significant difference does not, by itself, establish that the groups are equivalent, and the review did not demonstrate superior benefit for either population.

The evidence has important limitations. It was limited to four small observational studies, three of which used retrospective designs, and the participant group was dominated by breast-cancer and lymphoma or leukemia survivors. The pooled results therefore describe imaging-based changes in ventricular function over a mean follow-up of 9 ± 5 months rather than proven improvements in major clinical outcomes.

The authors concluded that CRT may be considered in cancer patients who meet standard criteria for implantation, while emphasizing that the decision should be individualized and guided by multidisciplinary assessment, cancer prognosis and competing clinical risks.

Subject of Research: Effects of cardiac resynchronization therapy on ventricular function in cancer therapy–related cardiac dysfunction

Article Title: Effectiveness of cardiac resynchronization therapy in cancer therapy–related cardiac dysfunction: a systematic review and meta-analysis

Article References: Magalhães, A., Araújo, I., Brabec, M., Menezes, M. N., Fiúza, M., & Caldeira, D. (2026). Effectiveness of cardiac resynchronization therapy in cancer therapy–related cardiac dysfunction: a systematic review and meta-analysis. Supportive Care in Cancer, 34(11), 1133. https://doi.org/10.1007/s00520-026-11364-9

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11364-9

Keywords: cardiac resynchronization therapy, cancer-related cardiac dysfunction, left-ventricular ejection fraction, end-systolic volume, reverse remodeling, cardio-oncology, systematic review, meta-analysis, non-ischemic cardiomyopathy, Effectiveness, cardiac, resynchronization