Efficacy and Safety of Shenfu Injection on Acute Heart Failure: A Systematic Review and Meta-Analysis

Tao, Lanting; Mo, Zhaofan; Li, Zunjiang; Li, Shuang; Luo, Ziqing; Li, Dongli; Wang, Dawei; Zhu, Wei; Ding, Banghan

doi:10.1016/j.phymed.2023.154641

Cited by 9 publications

(3 citation statements)

References 40 publications

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“…As a Chinese herbal formula, Shenfu injection has shown satisfactory therapeutic efficacy in several other clinical setting including cardiogenic shock 32 , cardiac arrest 17 and heart failure [33][34][35] , via the combination of multi-ingredients and multitargets. Extensive evidence from animal studies has indicated that Shenfu injection could effectively protect against sepsis-induced myocardial injury by inhibiting mitochondrial apoptosis 36 and attenuating lipopolysaccharide-induced myocardial inflammation 37 , and it might regulate the expression of adenosine receptors to ameliorate the ischemia-reperfusion injury 38 .…”

Section: Discussionmentioning

confidence: 99%

Effect of Shenfu Injection on Myocardial Injury After Primary PCI for STEMI: The RESTORE Trial

Wang,

Fan,

Jiang

et al. 2024

Preprint

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BACKGROUNDShenfu injection, as a traditional Chinese medicine, can alleviate reperfusion injury after ST-segment elevation myocardial infarction (STEMI) through multiple pharmacologic effects. This trial aimed to evaluate the effect of Shenfu injection on myocardial injury in STEMI patients undergoing primary percutaneous coronary intervention (PCI).METHODSThis was a multicenter, randomized, double-blind, parallel-group, placebo-controlled trial. First-time anterior STEMI patients undergoing primary PCI within 12 hours of symptom onset due to a proximal or mid left anterior descending artery occlusion were randomized 1:1 to receive either intravenous Shenfu injection or placebo before reperfusion and followed by once a day until 5 days after primary PCI. The primary endpoint was infarct size by cardiac magnetic resonance (CMR) at 5 days after randomization.RESULTSA total of 295 patients were randomized with evaluable CMR in 273 patients. Infarct size (37.4±14.1% vs 37.5±14.5%; effect size −0.04%, 95% confidence interval: −3.45, 3.37; P=0.982) did not differ between the Shenfu injection and placebo groups. This was true for other CMR parameters. The area under curve for creatine kinase-myocardial band did not differ between groups. The incidences of thrombolysis in myocardial infarction (TIMI) flow grade 3 (94.8% vs 97.1%, P=0.324), TIMI myocardial perfusion grade 3 (91.7% vs 92.1%, P=0.914), and ST-segment resolution ≥70% (25.4% vs 26.1%, P=0.906), were also similar between groups. Adverse events were evenly distributed across groups.CONCLUSIONSFor patients with anterior STEMI undergoing primary PCI, administration of Shenfu injection was safe but did not reduce infarct size by CMR.REGISTRATIONURL:https://www.clinicaltrials.gov; Unique identifier:NCT04493840.Clinical PerspectiveWhat Is New?Among 295 anterior ST-segment elevation myocardial infarction patients randomized to intravenous Shenfu injection or placebo, the primary analysis demonstrated that the infarct size revealed by cardiac magnetic resonance was 37.4 % in the Shenfu injection group and 37.5% in the placebo group, a difference that was not statistically significant.For patients with anterior ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention, administration of Shenfu injection was safe and well tolerated.What Are the Clinical Implications?Cardiovascular clinicians need to realize that successful cardioprotective therapies may require synergistic multitarget approaches.Future clinical trials are required to investigate the use of additive cardioprotective strategies in patients with large infarcts or severe hemodynamic alterations (eg. concomitant heart failure or cardiogenic shock).

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Section: Discussionmentioning

confidence: 99%

Effect of Shenfu Injection on Myocardial Injury After Primary PCI for STEMI: The RESTORE Trial

Wang,

Fan,

Jiang

et al. 2024

Preprint

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“…From a clinical perspective, Aconitum carmichaelii has been widely used as a cardiotonic drug in the clinical applications of traditional Chinese medicine ( Liu et al, 2012 ; Yang et al, 2014 ; Chen et al, 2022 ). Nowdays, the Shenfu Injection is still a successful traditional Chinese medicine formulation proved with both efficacy and safety ( Tao et al, 2023 ). Our present study not only demonstrate that the Aconitum carmichaelii extracted cardiotonic component Mesaconine could significantly improve the heart function with a wide therapeutic window, but also illustrate that the PINK1 dependent mitophagy was involved in the mesaconine’s cardio-protection effects.…”

Section: Discussionmentioning

confidence: 99%

Mesaconine alleviates doxorubicin-triggered cardiotoxicity and heart failure by activating PINK1-dependent cardiac mitophagy

et al. 2023

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Aberrant mitophagy has been identified as a driver for energy metabolism disorder in most cardiac pathological processes. However, finding effective targeted agents and uncovering their precise modulatory mechanisms remain unconquered. Fuzi, the lateral roots of Aconitum carmichaelii, shows unique efficacy in reviving Yang for resuscitation, which has been widely used in clinics. As a main cardiotonic component of Fuzi, mesaconine has been proven effective in various cardiomyopathy models. Here, we aimed to define a previously unrevealed cardioprotective mechanism of mesaconine-mediated restoration of obstructive mitophagy. The functional implications of mesaconine were evaluated in doxorubicin (DOX)-induced heart failure models. DOX-treated mice showed characteristic cardiac dysfunction, ectopic myocardial energy disorder, and impaired mitophagy in cardiomyocytes, which could be remarkably reversed by mesaconine. The cardioprotective effect of mesaconine was primarily attributed to its ability to promote the restoration of mitophagy in cardiomyocytes, as evidenced by elevated expression of PINK1, a key mediator of mitophagy induction. Silencing PINK1 or deactivating mitophagy could completely abolish the protective effects of mesaconine. Together, our findings suggest that the cardioprotective effects of mesaconine appear to be dependent on the activation of PINK1-induced mitophagy and that mesaconine may constitute a promising therapeutic agent for the treatment of heart failure.

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“…Based on available clinical evidence, traditional Chinese medicine is increasingly recognized for its significant role in the treatment of CHD and its complications ( Liu et al, 2022 ; Liu et al, 2023 ; Shen et al, 2023 ; Tao et al, 2023 ). Shuxuening injection (SXNI), a sterile preparation from folium Ginkgo [Yinxingye, Ginkgo biloba L.], is an botanical drug injection approved by the Chinese State Food and Drug Administration.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of Shuxuening injection in coronary heart disease: a systematic review and meta-analysis

Shi,

Sun,

et al. 2023

Front. Pharmacol.

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Background: Coronary heart disease (CHD) poses a serious threat to public health, and the current medical management still faces significant challenges. Reliable evidence on the efficacy of Shuxuening injection (SXNI) in CHD is still lacking, even though it is widely used in China.Purpose: To evaluate the efficacy of SXNI combination therapy in treating CHD.Methods: A systematic search of eight databases was conducted to identify relevant randomized controlled trials (RCTs) from the inception of each database until June 2023. ROB 2.0, RevMan 5.4, and Stata 15.1 were used for quality evaluation and data analysis. The Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the quality of evidence.Results: A total of 3,779 participants from 39 studies were included. The results showed SXNI combination therapy increased the clinical efficacy and decreased the frequency and duration of angina. Furthermore, SXNI combination therapy improved cardiac function of patients by decreasing LVEDD, and increased CI, CO, and LVEF. It also improved blood lipid profiles by increasing HDL, decreasing TC, TG, and LDL. The thrombosis factors of patients were also improved by decreasing FIB, PV, HCT, and HS. Moreover, SXNI combination therapy was superior to the conventional treatment in improving CRP levels, increasing ECG efficacy and BNP. However, due to the limited safety information, reliable safety conclusions could not be drawn. Furthermore, the levels of evidence ranged from very low to moderate due to publication bias and heterogeneity.Conclusion: SXNI can effectively improve angina symptoms, clinical efficacy, cardiac function, blood lipid indicators, and thrombosis factors of patients with CHD. However, more multi-center and large-sample studies are needed to confirm the conclusions due to the limitations of this study.Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?RecordID=399606; Identifier: CRD42023433292.

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Efficacy and Safety of Shenfu Injection on Acute Heart Failure: A Systematic Review and Meta-Analysis

Cited by 9 publications

References 40 publications

Effect of Shenfu Injection on Myocardial Injury After Primary PCI for STEMI: The RESTORE Trial

Effect of Shenfu Injection on Myocardial Injury After Primary PCI for STEMI: The RESTORE Trial

Mesaconine alleviates doxorubicin-triggered cardiotoxicity and heart failure by activating PINK1-dependent cardiac mitophagy

Effectiveness of Shuxuening injection in coronary heart disease: a systematic review and meta-analysis

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