Abstract
Introduction This network meta-analysis investigated the efficacy of six tonic Chinese herbal injections (Huangqi injection, Shenfu injection, Shengmai injection, Shenmai injection, Shenqi Fuzheng injection, and Yiqifumai injection) compared to Western medicine for the treatment of the deteriorating state associated with dilated cardiomyopathy. Methods PubMed, the Cochrane Library, Embase, the Chinese Biological Medicine Database, China National Knowledge Infrastructure, the Wanfang Database, and the Chinese Scientific Journal Database were searched from their inception to October 15, 2020, to retrieve randomized controlled trials (RCTs). Study selection and data extraction conformed to a priori criteria. The risk of bias of the included RCTs was determined, and GRADE was used to evaluate outcomes. The network meta-analysis was calculated using WinBUGS 1.4.3 and Stata 13.0 software. The clinical effective rate, left ventricular ejection fraction, 6-minute walk test, left ventricular end-diastolic dimension, heart rate, and cardiac output were deemed outcomes. All outcomes were summarized as odds ratios or mean differences with their 95% credible intervals. The ranking probability of the interventions across various outcomes was also presented. Results Forty RCTs and 2970 patients were enrolled. Integration of the outcome results revealed that a combination of Shenfu injection and Western medicine ranked ahead of the other injections in most outcomes, especially in the clinical effective rate (OR = 0.21, 95% CI: 0.12–0.34), left ventricular ejection fraction (MD = 7.43, 95% CI: 2.41–12.38), and 6-minute walk test (MD = 50.39, 95% CI: 25.78–76.33). Shenmai injection plus Western medicine ranked ahead of the other injections in left ventricular end-diastolic dimension (69.5%) and cardiac output (60.9%). The cluster analysis suggested that Shenfu injection plus Western medicine was the most effective intervention for dilated cardiomyopathy. Conclusions Shenfu injection plus Western medicine may be a preferable treatment in dilated cardiomyopathy. Clinicians should also consider the specific patient's various conditions when making diagnostic decisions. Due to an insufficient network meta-analysis, more high-quality RCTs need to be implemented to support our conclusions.
Highlights
Dilated cardiomyopathy (DCM) is the most common cardiomyopathy worldwide, and it refers to a heart muscle disease that is characterized by left ventricular and biventricular dilatation and systolic dysfunction without volume overload or coronary artery disease. ese conditions result in decreased cardiac output and stroke volume, increased end-diastolic pressure, and malignant arrhythmia, heart failure, and even sudden death [1,2,3,4]
Chinese herbal injections (CHIs) were used in the following proportions in the 40 randomized controlled trials (RCTs): Huangqi injection (7 RCTs), Shenfu injection (12 RCTs), Shengmai injection (7 RCTs), Shenmai injection (12 RCTs), Shenqi Fuzheng injection (1 RCT), and Yiqifumai injection (1 RCT)
Huangqi injection + Western medicine (WM), Shenfu injection + WM, Shengmai injection + WM, and Shenmai injection + WM were more effective in promoting the clinical effective rate compared to WM and had statistically significant differences. e ranking analysis suggested that Shenfu injection + WM was more efficacious for the clinical effective rate with a probability of 78.5% (Table 3)
Summary
Dilated cardiomyopathy (DCM) is the most common cardiomyopathy worldwide, and it refers to a heart muscle disease that is characterized by left ventricular and biventricular dilatation and systolic dysfunction without volume overload or coronary artery disease. ese conditions result in decreased cardiac output and stroke volume, increased end-diastolic pressure, and malignant arrhythmia, heart failure, and even sudden death [1,2,3,4]. With the promotion of traditional Chinese medicine, its utilization is becoming increasingly instrumental to the treatment of DCM. Traditional Chinese medicine theories consider DCM a “heart impediment,” “chest obstruction,” and “edema” that emerges in the heart and affects the lung, spleen, and kidney [7, 9]. Tonic CHIs refer to injections whose main components are ginseng, astragalus, and Ophiopogon japonicus, which have the functions of replenishing qi, nourishing blood, nourishing yin, and assisting yang, and are primarily used to treat various deficiency symptoms. E present network meta-analysis (NMA) incorporated six common tonic CHIs that are used in the treatment of DCM, namely, Huangqi injection, Shenfu injection, Shengmai injection, Shenmai injection, Shenqi Fuzheng injection, and Yiqifumai injection, to determine their efficacy. Tonic CHIs refer to injections whose main components are ginseng, astragalus, and Ophiopogon japonicus, which have the functions of replenishing qi, nourishing blood, nourishing yin, and assisting yang, and are primarily used to treat various deficiency symptoms. e present network meta-analysis (NMA) incorporated six common tonic CHIs that are used in the treatment of DCM, namely, Huangqi injection, Shenfu injection, Shengmai injection, Shenmai injection, Shenqi Fuzheng injection, and Yiqifumai injection, to determine their efficacy. e China Food and Drug Administration authorized all of these tonic CHIs
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