Shengmai (a traditional Chinese herbal medicine) for heart failure

Jin Chen; Gang Wu; Shuangqing Li; Tao Yu; Yao Xie; Liping Zhou; Lei Wang

doi:10.1002/14651858.CD005052.pub2

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Figure 1

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Analysis 1.1

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 1 Lack of improvement in heart failure ( NYHA class improved < I class or worsening of heart failure).

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Analysis 1.2

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 2 mortality at the end of treatment.

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Analysis 1.3

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 3 cardiac output (L/min) change at 2 weeks.

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Analysis 1.4

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 4 stroke volume (ml) change at 2 weeks.

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Analysis 1.5

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 5 cardiac index change at 2 weeks.

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$Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 6 eject fraction change at 2 weeks.$

Analysis 1.6

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 6 eject fraction change at 2 weeks.

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Analysis 1.7

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 7 system vascular resistance change at 2 weeks.

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Analysis 1.8

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 8 left ventricular minor axis shortened rate change at 2 weeks.

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Analysis 1.9

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 9 ventricular wall thickened rate change at 2 weeks.

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Analysis 1.10

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 10 Exercise time in movement tolerance test at 2 weeks.

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Analysis 1.11

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 11 heart rate multiply systolic blood press (mmHg) at the end of movement tolerance test at 2 weeks.

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Analysis 1.12

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 12 flow mediated dilation of brachial artery volume change at 2 weeks.

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Analysis 1.13

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 13 eletrocardiogram QT dispersion change at 20 days.

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Analysis 1.14

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 14 electrocardiogram JT dispersion change at 20 days.

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Analysis 1.15

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 15 tumor necrosis factor‐alpha change at 14 days.

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Analysis 1.16

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 16 endogenous digitalis‐like factors change at 14 days.

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Analysis 1.17

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 17 Plasma P‐selectin change at 2 weeks.

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Analysis 1.18

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 18 von Willebrand's factor change at 2 weeks.

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Analysis 1.19

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 19 D‐dimer change at 2 weeks.

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Analysis 1.20

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 20 partial pressure of oxygen increase at 10 days.

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Analysis 1.21

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 21 partial pressure of carbon dioxide decrease at 10 days.

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Analysis 1.22

Comparison 1 Shengmai +usual treatment versus usual treatment, Outcome 22 B‐type natriuretic peptide change at 15 days.

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Table 1. MEDLINE search strategy

1.shengmai*
2.sengmai
3.senmai
4.MEDICINE CHINESE TRADITIONAL
5.DRUGS CHINESE HERBAL
6.herb*
7.chinese near medicine*
8.chinese near drug*
9.ginseng*
10.liriope
11.schisandra
12.shen next mai
13.sen next mai
14.panax
15.schizandra
16.ophiopogon*
17.#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9
18.#10 or #11 or #12 or #13 or #14 or #15 or #16
19.#17 or #18
20.HEART FAILURE CONGESTIVE
21.heart next failure
22.cardiac next failure
23.VENTRICULAR DYSFUNCTION
24.(ventricular near dysfunction)
25.(cardiac next insufficiency)
26.heart next insufficiency
27.ventric* next fail*
28.#20 or #21 or #22 or #23 or #24 or #25 or #26 or #27
29.#28 and #19

Table 1. MEDLINE search strategy

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Table 2. EMBASE search strategy

1.shengmai*
2.sengmai
3.senmai
4.MEDICINE CHINESE TRADITIONAL
5.DRUGS CHINESE HERBAL
6.(chinese near medicine*)
7.chinese near drug
8.ginseng*
9.liriope
10.schisandra
11.herb*
12.shen next mai
13.sen next mai
14.panax
15.schizandra
16.ophiopogon*
17.#1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9
18.#10 or #11 or #12 or #13 or #14 or #15 or #16
19.#17 or #18
20.HEART FAILURE CONGESTIVE
21.heart failure
22.cardiac failure
23.VENTRICULAR DYSFUNCTION
24.ventricular near dysfunction
25.cardiac insufficiency
26.heart insufficiency
27.ventric* fail*
28.#20 or #21 or #22 or #23 or #24 or #25 or #26 or #27
29.#28 and #19

Table 2. EMBASE search strategy

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Table 3. AMED search strategy

1.shengmai$
2.sengmai
3.senmai
4.Traditional medicine chinese
5.Drugs chinese herbal
6.herb$
7.chinese near medicine$
8.chinese near drug$
9.ginseng$
10.liriope
11.schisandra
12.shen near mai
13.sen next mai
14.panax
15.schizandra
16.ophiopogon$
17.1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9
18.10 or 11 or 12 or 13 or 14 or 15 or 16
19.17 or 18
20.Heart failure congestive
21.heart next failure
22.cardiac next failure
23.Heart disease
24.ventricular near dysfunction
25.cardiac next insufficiency
26.heart next insufficiency
27.ventric$ next fail$
28.20 or 21 or 22 or 23 or 24 or 25 or 26 or 27
29.19 and 28

Table 3. AMED search strategy

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Table 4. BIOSIS search strategy

1.shengmai$
2.sengmai
3.senmai
4.MEDICINE CHINESE TRADITIONAL
5.DRUGS CHINESE HERBAL
6.herb$
7.chinese medicine$
8.chinese drug$
9.ginseng$
10.liriope
11.schisandra
12.shen mai
13.sen mai
14.panax
15.schizandra
16.ophiopogon$
17.1 or 2 or 3 or 4 or 5 or 6 or 7 or 8 or 9
18.10 or 11 or 12 or 13 or 14 or 15 or 16
19.17 or 18
20.HEART FAILURE CONGESTIVE
21.heart failure
22.cardiac failure
23.VENTRICULAR DYSFUNCTION
24.ventricular dysfunction
25.cardiac insufficiency
26.heart insufficiency
27.ventric$ fail$
28.20 or 21 or 22 or 23 or 24 or 25 or 26 or 27
29.28 and 19

Table 4. BIOSIS search strategy

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Table 5. Characteristics of participants

Study	Number	Sex	Average age	Duration of HF	Original disease	Heart Function
Gao 2001	112	M/F 81/31	66.8		PHD 112
Ma 2003	60	M/F 32/28	65‐67	5.4‐6.3 years	CHD/RHD/HBP/DCM 47/5/6/2	II/III/IV 13/32/15
Sun 1998	52	M/F 29/23	55‐57		CHD/RHD/HBP 20/14/11	III/IV 23/29
Zhang 2002	100	M/F 59/41	58‐60	6 months‐8 years	DCM 100	II/III/IV 20/71/9
Cen 1999	82	M/F 67/15	69‐70		CHD/RHD/HBP/DCM/PHD 38/12/17/1/14
He 2004	60		41		CHD/RHD/HBP/DCM 21/12/15/12	II/III/IV 8/34/18
Mao 2003	80					II/III 27/53
Liao 1996	90	M/F 57/33	65‐66	average 8 years	CHD/RHD/HBP/DCM/PHD/others 38/9/4/7/27/5	I/II/III 17/33/40
Cheng 2001	220	M/F144/76	56‐57	average 9.5‐9.7 years	PHD 220
Wang 2004	62	M/F 44/18	59‐60	average 7.5‐7.8 years	CHD/RHD/HBP/DCM/PHD 18/9/17/9/9	II/III/IV 18/25/19
Li 2003	154	M/F 82/72	63		PHD 154	III/IV 102/52
Hu 1998	80	M/F 64/16	56‐58			III/IV 68/10
He 2001	80	M/F 54/26	48‐50
Li 2004	57	M/F 32/25	72‐73	average 7.5‐7.9 years	CHD/HBP/DCM 37/18/2	III/IV 19/38
Wang 1997b	100	M/F 54/46	49‐50		CHD/RHD/DCM 31/51/18	II/III/IV 5/64/31
Li 1998b	64	M/F 42/22	69‐72		PHD 64
Tang 2001	66	M/F 41/25	64‐65	2‐12 years	CHD/RHD/HBP/DCM/PHD 23/19/7/4/13
Li 1998a	82	M/F 54/28	56‐64	1‐14 years	CHD/RHD/PHD 40/34/8	II/III/IV 20/32/30
Mao 1998	62	M/F 53/9	67‐68	5‐41 years

Table 5. Characteristics of participants

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Table 6. Characteristics of shengmai treatment

Study	Agent	Dose	Form	Duration of treat
Gao 2001		25 mL + 5% GS 250ml/iv gtt qd	injection	10d
Ma 2003	Huaxi	100 mL + 5% GS 200ml/iv gtt qd	injection	14d
Sun 1998	Huaxi	50 mL +1 0% GS 250ml/iv gtt qd	injection	10d
Zhang 2002	Huaxi	60 mL + 5% GS 250ml/iv gtt qd	injection	14d
Cen 1999		100mL + 5% GS 150ml/iv gtt qd	injection	20d
He 2004	Huaxi	20‐40 mL + GS /iv gtt qd	injection	14d
Mao 2003	Yibin	20,40,60 mL + 5% 200 mL polarized solution /iv gtt qd	injection	14d
Liao 1996		50 mL + 10% GS 250 mL/iv gtt qd	injection	10d
Cheng 2001	Suzhong	40‐60 mL + 5% GS 250‐500 mL/iv gtt qd	injection	(10‐15d)*1.5
Wang 2004	Suzhong	20‐30 mL +5% GS 250 mL/iv gtt qd	injection	14d
Li 2003	Suzhong	30 mL +5 % GS 250 mL/iv gtt qd	injection	21d
Hu 1998	Suzhong	10 mL + 5% GS 200 mL/iv gtt q12h	injection	10d
He 2001	Suzhong	40‐60 mL + 5% GS 250 mL/iv gtt qd	injection	14d
Li 2004	Hehuang	60 mL + 5% GS 250‐500 mL/iv gtt qd	injection	15d
Wang 1997b		60 mL +5% GS 250 mL/iv gtt qd	injection	14d
Li 1998b	Huaxi	40 mL /iv gtt qd	injection	10d
Tang 2001		20 mL +10% GS 250 mL/iv gtt qd	injection	14d
Li 1998a	Huaxi	30‐50 mL + 10% GS 250 mL/iv gtt q12h	injection	15d
Mao 1998	Yibin	100 mL +5% GS 250‐500 mL/iv gtt qd	injection	14d*(1‐2)

Table 6. Characteristics of shengmai treatment

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Comparison 1. Shengmai +usual treatment versus usual treatment

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Lack of improvement in heart failure ( NYHA class improved < I class or worsening of heart failure) Show forest plot	18	1606	Risk Ratio (M‐H, Fixed, 95% CI)	0.32 [0.25, 0.40]

2 mortality at the end of treatment Show forest plot	1		Risk Ratio (M‐H, Fixed, 95% CI)	Totals not selected

3 cardiac output (L/min) change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

4 stroke volume (ml) change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

5 cardiac index change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

6 eject fraction change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

7 system vascular resistance change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

8 left ventricular minor axis shortened rate change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

9 ventricular wall thickened rate change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

10 Exercise time in movement tolerance test at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

11 heart rate multiply systolic blood press (mmHg) at the end of movement tolerance test at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

12 flow mediated dilation of brachial artery volume change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

13 eletrocardiogram QT dispersion change at 20 days Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

14 electrocardiogram JT dispersion change at 20 days Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

15 tumor necrosis factor‐alpha change at 14 days Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

16 endogenous digitalis‐like factors change at 14 days Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

17 Plasma P‐selectin change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

18 von Willebrand's factor change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

19 D‐dimer change at 2 weeks Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

20 partial pressure of oxygen increase at 10 days Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

21 partial pressure of carbon dioxide decrease at 10 days Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

22 B‐type natriuretic peptide change at 15 days Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Totals not selected

Comparison 1. Shengmai +usual treatment versus usual treatment

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