Traditional Chinese Medicine Intervenes Ventricular Remodeling Following Acute Myocardial Infarction: Evidence From 40 Random Controlled Trials With 3,659 Subjects.

Xiao-Xiao Zhang,Chang-Le Shao,Bo Liang,Ning Gu

doi:10.3389/fphar.2021.707394

Abstract

Objectives: We intend to conduct a meta-analysis on the systematic evaluation of traditional Chinese medicine (TCM) in the treatment of ventricular remodeling following acute myocardial infarction (AMI). Our findings may provide certain references for the clinical treatment of ventricular remodeling.Methods: A systematic literature search was conducted in PubMed, Web of Science, Cochrane Library, Embase, CNKI, Wanfang Data, CQVIP, and CBM before 20 July 2020. Data were analyzed using a random/fixed-effect model. Primary outcomes included the effectiveness and TCM syndrome score (TCMSS). Secondary outcomes included 1) echocardiography data, including the left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic volume index (LVEDVi), left ventricular end-systolic volume index (LVESVi), left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), interventricular septum thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (LVEF), E/A, stroke volume (SV), and wall motion score (WMS); 2) serum indicators, including the B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP), and C-reactive protein (CRP) or high sensitivity CRP (hs-CRP); (3) major adverse cardiovascular events (MACE) and other adverse eventsResults: Forty RCTs involving 3,659 subjects were recruited. Our findings proved that a combination of TCM or TCM preparations with conventional Western medicine for preventing and reversing ventricular remodeling at post-AMI could remarkably enhance the total effectiveness and reduced TCMSS. Moreover, myocardial functions (LVEF, E/A, and SV), ventricular remodeling (LVEDVi, LVESVi, LVEDV, LVESV, LVEDD, LVESD, LVPWT, and WMS), serum levels of BNP and CRP, and MACE were significantly improved by the combination of TCM or TCM preparations with conventional Western medicine. Nevertheless, IVST and the incidence of other adverse events were comparable between control and experimental groupsConclusion: The combination of TCM or TCM preparations and conventional Western medicine can alleviate the process of ventricular remodeling, enhance cardiac function, and reduce the incidence of MACE in AMI patients.

Highlights

With the emergence and gradual application of percutaneous coronary intervention, the mortality due to acute myocardial infarction (AMI) has sharply declined (Bajaj et al, 2015)
The guidelines recommend that angiotensinconverting enzyme inhibitors (ACEIs) should be applied to all AMI patients as soon as possible, and angiotensin II receptor blockers (ARBs) is recommended for patients who cannot tolerate ACEI
Excessive inflammation will aggravate the occurrence of fibrosis and lead to pathological remodeling (Kaneko et al, 2011; Anzai, 2018; Rita et al, 2018) Our results revealed that combining treatment of Traditional Chinese medicine (TCM) or TCM preparations with Western medicine more obviously reduced serum level of CRP in AMI patients than those who solely treated with Western medicine (p < 0.05)

Summary

Introduction

With the emergence and gradual application of percutaneous coronary intervention, the mortality due to acute myocardial infarction (AMI) has sharply declined (Bajaj et al, 2015). The global burden of cardiovascular diseases and AMI mainly concentrates on low- and middleincome countries. More than 80% of deaths from cardiovascular diseases occur in these countries (Murray et al, 2012; Murray et al, 2015). Reduced cardiomyocytes and poor development of viable cardiomyocytes and extracellular matrix are the chief criminals of ventricular remodeling. They trigger adverse cardiac events and activate multiple-system functions like the neurohormonal pathway due to the declined systolic function (McMurray, 2005). A vicious circle following AMI further aggravates ventricular remodeling, thereafter leading to the deterioration of cardiac function, heart failure, malignant arrhythmia, and even cardiac death

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