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SYSTEMATIC REVIEW article

Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1374114

Effect of astragalus injection on left ventricular remodeling in HFmrEF: a systematic review and meta-analysis

Provisionally accepted
Xu Han Xu Han 1*Lumei Huang Lumei Huang 2Geng Li Geng Li 1Xinglang Mou Xinglang Mou 2Caihong Cheng Caihong Cheng 2
  • 1 Chongqing Changshou Traditional Chinese Medicine Hospital, Chongqing, China
  • 2 Chongqing Dianjiang County Hospital of Traditional Chinese, Chongqing, China

The final, formatted version of the article will be published soon.

    The aim of this meta-analysis is to evaluate the effect of astragalus injection (AI) on left ventricular remodeling (LVR) in patients with heart failure with mildly reduced ejection fraction (HFmrEF).The randomized controlled trials (RCTs) of AI in treating HFmrEF were retrieved from 8 major English and Chinese electronic databases, up until November 30, 2023. To evaluate the methodological quality of the included studies, the Cochrane bias risk tool and the Modified Jadad Scale were employed. Stata 17.0 software was utilized for statistical analysis, sensitivity analysis, and assessment of publication bias.Results: Ten RCTs with 995 patients (562 males and 433 females) were identified. Meta-analysis indicated that compared to conventional treatment (CT), AI significantly improved LVR, specifically increasing left ventricular ejection fraction (LVEF, MD = 4.56, 95% CI: 3.68 to 5.44, p < 0.00001), decreasing left ventricular end-diastolic volume (LVEDV, MD = -7.89, 95% CI: -11.13 to -4.64, p < 0.00001), left ventricular end-diastolic diameter (LVEDD, MD = -4.18, 95% CI: -5.79 to -2.56, p < 0.00001), left ventricular end-systolic volume (LVESV, MD = -8.11, 95% CI: -11.79 to -4.43, p < 0.00001), and left ventricular end-systolic diameter (LVESD, MD = -3.42, 95% CI: -4.90 to -1.93, p < 0.00001). AI also improved clinical efficacy (RR = 4.62, 95% CI: 3.11 to 6.88, p < 0.00001), reduced N-terminal pro-brain natriuretic peptide (NT-pro BNP, MD = -27.94, 95% CI: -43.3 to -12.36) level, without increasing the incidence of adverse reactions (RR = 1.60, 95% CI: 0.59 to 4.29, p = 0.35). Sensitivity analysis confirmed the reliability of the merged results, and Begg's and Egger's tests showed no significant publication bias.The systematic review and meta-analysis revealed that combining AI with CT improves LVR without increasing adverse events in HFmrEF patients. However, caution is needed in interpreting the results due to limited evidence. Future high-quality RCTs are needed to support these conclusions.

    Keywords: Astragalus injection, heart failure with mildly reduced ejection fraction, left ventricular remodeling, randomized controlled trials, Systematic review, Meta-analysis

    Received: 02 Feb 2024; Accepted: 29 Jul 2024.

    Copyright: © 2024 Han, Huang, Li, Mou and Cheng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Xu Han, Chongqing Changshou Traditional Chinese Medicine Hospital, Chongqing, China

    Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.