Objective To evaluate the clinical therapeutic effect and safety of western medicine plus Shenfu Injection versus simple western medicine in heart failure (HF) patients. Methods Such databases as CNKI (January 1979 to 2009), VIP (January 1989 to December 2009), CBM (1978 to 2009), PubMed (1978 to December 2009), The Cochrane Library (Issue 4, 2009) and relevant journals were searched, and the literature of randomized controlled trials comparing the combination of western medicine and Shenfu Injection with simple western medicine in HF patients was included. The quality of studies was evaluated according to the methods of the Cochrane Collaboration, the data were extracted; and meta-analyses were performed with RevMan5.0.2 software. Results Sixteen trials involving 1 117 patients were included. The results of meta-analyses showed that compared with the simple western medicine treatment, the combination of western medicine and Shenfu Injection therapy significantly improved the symptoms, clinical comprehensive effect (RR=3.30, 95%CI 2.22 to 4.92, Plt;0.000 01), TCM syndrome and patient’s quality of life (RR=6.85, 95%CI 2.90 to 16.17, Plt;0.000 01), increased left ventricular ejection fraction (WMD=3.54, 95%CI 2.78 to 4.30, Plt;0.000 01), and reduced LVSD (WMD=2.43, 95%CI 1.04 to 3.82, P=0.000 6). Meanwhile, only one trail indicated that the combination of western medicine and Shenfu Injection might increase the six-minute walking distance, reduce the level of IL-6 and TNF-α, and eliminate the Lee’s HF and LVD-36 questionnaire integral. Conclusion The therapeutic effect of combining western medicine with Shenfu Injection therapy on HF patients is better than that of simple western medicine treatment.
Objective To evaluate the clinical effect and safety of western medicine plus Shenmai Injection versus western medicine alone for heart failure (HF) patients. Methods We searched CNKI (January 1979 to April 2009), VIP (January 1989 to April 2009), CBM (1978 to 2009), PubMed (1978 to April 2009), The Cochrane Library (Issue 3, 2009), and other relevant databases and journals to identify randomized controlled trials (RCTs) about western medicine plus Shenmai Injection versus western medicine alone for HF patients. The methodological quality was assessed and the data was extralted according to the Cochrane Reviewer’s Handbook and related methods. Meta-analyses were performed using RevMan 5.0.2 software.Results Fifteen eligible studies involving 1174 HF patients were included. The results of meta-analyses showed that western medicine plus Shenmai Injection therapy could precisely improve the general therapeutic effects (RR=1.27, 95%CI 1.19 to 1.35, Plt;0.000 01), increase left ventricular ejection fraction (WMD=7.17, 95%CI 4.65 to 9.70, Plt;0.000 01), and make ventricular diastolic function better (minor weight literature: WMD=0.38, 95%CI 0.32 to 0.45, Plt;0.000 01; major weight literature: WMD=0.38, 95%CI 0.32 to 0.45). Meanwhile, only one study indicated that western medicine plus Shenmai Injection could increase 6-minute walking distance, reduce BNP, IL-6, and TNF-α levels, respectively. Conclusion By comparison with western medicine alone, western medicine plus Shenmai Injection can improve the therapeutic effect on HF patients.
ObjectivesTo systematically review the efficacy of Qiliqiangxin capsule on cardiac function in patients with heart failure with preserved ejection fraction (HFpEF).MethodsCNKI, VIP, WanFang Data, CBM, EMbase, PubMed and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) of Qiliqiangxin capsule for HFpEF from inception to August 1st, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was performed by RevMan5.3 software.ResultsA total of 24 RCTs involving 2 021 patients were included. The results of meta-analysis showed that Qiliqiangxin capsule combined with conventional western medicine could improve E/A wave ratio (MD=0.17, 95%CI 0.13 to 0.21, P<0.000 01), reduce E/e' wave ratio (MD=−2.16, 95%CI −3.23 to −1.08, P<0.000 1), BNP (MD=−240.43, 95%CI −357.66 to −123.20, P<0.000 1), and NT-proBNP (MD=−200.64, 95%CI −290.02 to −111.27, P<0.000 1). However, there were no statistically significant differences between two groups in re-hospitalization rate (RR=0.57, 95%CI 0.27 to 1.19, P=0.13), mortality (RR=0.33, 95%CI 0.04 to 3.05, P=0.33), and incidence of adverse events (RR=0.59, 95%CI 0.26 to 1.34, P=0.20).ConclusionsThe present evidence shows that Qiliqiangxin capsule combined with conventional western medicine can improve neuroendocrine disorders and cardiac structure in patients with HFpEF, and further improve cardiac diastolic function. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
ObjectiveTo systematically review the efficacy and safety of Xinmailong injection in the treatment of different types of heart failure with ejection fraction.MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) of Xinmailong injection in the treatment of different types of heart failure with ejection fraction from inception to August 5th, 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 25 RCTs involving 2 467 patients were included. The results of meta-analysis showed that Xinmailong injection combined with conventional therapy was superior to conventional therapy alone on NYHA classification efficiency (HFrEF: RR=1.32, 95%CI 1.04 to 1.69, P=0.02), comprehensive clinical efficacy (HFrEF: RR=1.24, 95%CI 1.15 to 1.34, P<0.000 01; HFpEF: RR=1.22, 95%CI 1.15 to 1.30, P<0.000 01), score of life quality (HFrEF: MD=−7.08, 95%CI −9.34 to −4.82, P<0.000 01), left ventricular ejection fraction (HFrEF: MD=4.99, 95%CI 3.18 to 6.80, P<0.000 01; HFpEF: MD=5.10, 95% CI 0.62 to 9.58, P=0.03), the level of B-type natriuretic peptide (HFrEF: SMD=−0.96, 95%CI −1.36 to −0.56, P<0.000 01; HFpEF: SMD=−1.83, 95%CI−2.35 to −1.31, P<0.000 01), the level of N-terminal pro-B natriuretic peptide (HFrEF: SMD=−2.98, 95%CI −4.45 to −1.51, P<0.000 1), and 6-minute walking distance (HFrEF: MD=52.56, 95%CI 34.22 to 70.90, P<0.000 01). There was no significant difference in drug-related adverse reactions between two groups.ConclusionsCurrent evidence shows that Xinmailong injection combined with conventional therapy have good efficacy and safety in the treatment of heart failure with different ejection fractions. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
The fundamental reason why the organic lesions of chronic heart failure are difficult to reverse is ventricular remodeling. Myocardial fibrosis (MF) is an important pathological basis of ventricular remodeling. Its development process involves complex biological mechanisms and neuroendocrine system. Extracellular signal-regulated kinase (ERK) pathway is a classic pathway for the treatment of tumors. It is found that the inhibition of the ERK pathway can also slow down the progressive aggravation of MF. Therefore, exploring the mechanism of ERK pathway in MF may provide a new idea for the prevention and treatment of chronic heart failure. In this paper, the mechanism of ERK pathway in the occurrence and development of MF and its inhibition drugs were described, in order to provide evidence for the prevention and treatment of MF in chronic heart failure based on this pathway.
ObjectivesTo analyze the application value of 6-minute walking test (6MWT) in the clinical evaluation of chronic heart failure (CHF).MethodsPubMed, EMbase, The Cochrane Library, CBM, VIP, WanFang Data and CNKI databases were searched online to collect randomized controlled trials (RCTs) of 6-minute walking distance (6MWD) as the CHF evaluation index. Two reviewers independently screened literature, extracted data, and then analyzed data by using SPSS 17.0 statistical software. The 6MWD with symptom, quality of life, exercise tolerance (ETT), left ventricular ejection fraction (LVEF), peak oxygen consumption (pVO2) were analyzed by Kappa consistency test, and the possible influencing factors of 6MWD were analyzed by logistic regression.ResultsA total of 158 RCTs involving 17 853 patients were included. The results of statistical analysis showed that: 6MWD was consistent with the improvement of symptoms, quality of life, ETT, LVEF and pVO2 (Kappa>0.4). Baseline 6MWD (OR=2.91, 95%CI 1.278 to 6.634,P=0.011) and NYHA Ⅲ-Ⅳ ratio (OR=2.59, 95%CI 1.091 to 6.138, P=0.031) were the independent influencing factors for 6MWD improvement separately.ConclusionsThe 6MWT is an objective and reliable indicator of CHF evaluation.