Abstract
Astragalus membranaceus (AM) is a traditional Chinese medicine, which possesses a variety of biological activities in the cardiovascular systems. We conducted a clinical and preclinical systematic review of 28 randomized clinical control studies with 2522 participants and 16 animal studies with 634 animals to evaluate the efficacy, safety, and possible mechanisms of AM for viral myocarditis (VM). The search strategies were performed in 7 databases from inception to January 2020. Application of the Cochrane Collaboration's tool 7-item checklist, SYRCLE's tool 10-item checklist, and Rev-Man 5.3 software to analyze the risk of bias of studies and data. The results show the score of clinical study quality ranged from 3 to 7 points with an average of 3.32, and the score of animal study quality ranged from 2 to 5 points with an average of 3. In clinical study, AM significantly reduced serum myocardial enzymes and cardiac troponin I levels and improved the clinical treatment efficiency in VM patients compared with the control group (P < 0.05). There was no significant difference in the incidence of adverse reactions (P > 0.05). Significant increase of the survival rate and decrease of the cardiac cardiology score, cardiac enzymes, and cardiac troponin I were compared with the placebo group in animal studies (P < 0.05). The possible mechanisms of AM are largely through antivirus and antivirus receptors, anti-inflammatory, antioxidation, antiapoptotic, antifibrosis, and reducing cardiac calcium load. In conclusion, the findings suggested that AM is a cardioprotection candidate drug for VM.
Highlights
Viral myocarditis (VM) is defined as the inflammatory disease that injured the muscular tissues of the heart, which refers to the pathological lesion including focal or diffuse myocardial cell degeneration and necrosis, interstitial inflammatory cell infiltration, and fibrous exudation caused by viruses [1]
Detailed inspection was performed to remaining full-text studies; 145 studies were excluded according to the inclusion and exclusion criteria
Detailed inspection was performed to remaining full-text studies; 126 studies were excluded according to the inclusion and exclusion criteria
Summary
Viral myocarditis (VM) is defined as the inflammatory disease that injured the muscular tissues of the heart, which refers to the pathological lesion including focal or diffuse myocardial cell degeneration and necrosis, interstitial inflammatory cell infiltration, and fibrous exudation caused by viruses [1]. The acute inflammation may develop into subacute and chronic gradually to tissue remodeling, fibrosis, and loss of myocardium architecture and contractile function leading the myocarditis of dilated cardiomyopathy (DCM) [2]. It may cause acute heart failure (AHF) and sudden death which is counted at 10% of total sudden death [3]. Establishing the potential benefits of immunomodulators and antiviral therapy is currently at the preliminary research stage [6] Great progress such as intra-aortic balloon pump, ventricular assist device, or extracorporeal membrane oxygenation has been reached in the treatment of cardiac end-point events, the more important goal is to prevent or delay their progress and prevent complications in VM patients [7]. How to effectively treat VM and prevent AHF has attracted more and more attention to the world
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