Efficacy and safety of Shenfu injection for the treatment of post-acute myocardial infarction heart failure: A systematic review and meta-analysis

Abstract

Objective: This systematic review and meta-analysis aimed to investigate the adjuvant effect and safety of Shenfu injection (SFI) on the treatment of post-acute myocardial infarction heart failure (PAMIHF).Methods: Seven databases were searched to identify randomized controlled trials (RCTs) associated with SFI and PAMIHF treatment from May 1990 to May 2022. Primary outcomes included NT-proBNP and left ventricular ejection fraction (LVEF), and secondary outcomes included total effective rate, BNP, heart rate (HR), cardiac output (CO), and adverse event (AE). The risk of bias evaluation was assessed by the ROB2 tool, meta-analysis, subgroup analysis, sensitivity analysis, and publication bias were conducted by RevMan5.3 software, and the Grade of Recommendations, Assessment, Development, and Evaluations (GRADE) system was used to evaluate the quality of evidence of meta results.Results: A total of 36 studies with 3231 PAMIHF patients were included. The meta results suggested that adjuvant SFI therapy was superior to conventional medical therapy alone. It improved the total effective rate [RR = 1.33; 95% CI (1.25.1.40); p < 0.00001], increased LVEF [SMD = 0.98; 95% CI (0.71, 1.24); p < 0.00001], and decreased HR [SMD = −1.14; 95% CI (−1.28, −0.99); p < 0.00001]. In addition, adjuvant SFI therapy (9.73%, 66/678) had a rate of AE lower than that of conventional medical therapy alone (21.7%, 147/677) when regarding safety [RR = 0.45; 95% CI (0.35, 0.57); p < 0.00001]. The quality of the evidence for the outcomes was rated from “very low” to “moderate.”Conclusion: Adjuvant SFI therapy was safer to improve the total effective rate and the heart function of PAMIHF patients. However, well-designed RCTs were needed to confirm the efficacy and safety of adjuvant SFI therapy in PAMIHF treatment due to the low quality of the evidence for the outcomes caused by a small sample size and unclear risk of bias existed in included studies.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=151856), identifier CRD42020151856.

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

“…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 .…”

Protective Effect of Ginsenoside Rg5 on Hypoxia/Reoxygenation- Induced H9c2 Cardiomyocytes by Correcting Free Fatty Acids β- oxidation

“…Therefore, we turned our attention to Chinese herbal medicines and their prescriptions. In China, clinical trials [24,[50][51][52][53][54] have demonstrated that SFI has a good therapeutic effect and high safety. The main active components of SFI are ginsenosides and alkaloids.…”

“…The representative compound preparation for the clinical treatment of CS in China is Shenfu injection (SFI). SFI can effectively treat CS by protecting the myocardium, improving hematology, adjusting myocardial energy metabolism, and anti-shock and antiarrhythmia [21][22][23][24][25][26][27]. SFI is a traditional Chinese medicine injection prepared from the extraction of red ginseng and Radix Aconiti, and its components include ginsenosides and alkaloids.…”

Comparative efficacy of five traditional Chinese medicine injections for treating heart failure with reduced and mildly reduced ejection fraction: Bayesian network meta-analysis

“…Five TCMIs, Shenfu injection (SFI), Shenmai injection (SMI), Danhong injection (DHI), Xinmailong injection (XMLI), and Huangqi injection (HQI), are commonly used to treat different types of HF. SFI protects the myocardium, improves hemodynamics, and dilates blood vessels [ 17 ]. SMI can eliminate oxygen-derived free radicals and protect myocardial cells [ 18 ].…”