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. 2024 Apr 9:15:1370448.
doi: 10.3389/fphar.2024.1370448. eCollection 2024.

Xinmailong injection on left ventricular remodeling and inflammatory mediators in patients with CHF: a systematic review and meta-analysis

Xu Han  1 , Xi Chen  1 , Yanling Liu  2 , Jie Yang  2 , Wuzhi Nie  2 , Mingjiu Yang  2 , Xinglang Mou  2
Affiliations

Xinmailong injection on left ventricular remodeling and inflammatory mediators in patients with CHF: a systematic review and meta-analysis

Xu Han et al. Front Pharmacol. .

Abstract

Background: Chronic heart failure (CHF) is a prevalent and highly challenging cardiovascular disease associated with high mortality rates. The occurrence and progression of CHF are closely linked to left ventricular remodeling (LVR) and inflammation. Addressing LVR and reducing inflammation can significantly slow down the progression of CHF and improve patient prognosis.

Objective: To evaluate the effects of Xinmailong injection (XMLI) on LVR and inflammatory mediators in CHF patients.

Method: The randomized controlled trials investigating the effectiveness of XMLI treatment for CHF were retrieved from eight databases up until 31 December 2023. To evaluate the methodological quality of included studies, the Cochrane bias risk tool was employed. Furthermore, statistical analysis, sensitivity analysis, and publication bias assessment were conducted using Stata 17.0 software.

Result: Compared with conventional treatment (CT), the combination therapy of XMLI and CT significantly improved LVR and reduced inflammatory mediators, mainly manifested by an increase in LVEF (MD = 6.40, 95% CI: 5.25 to 7.55, p = 0.000), a decrease in LVEDD (MD = -4.63, 95% CI: -5.69 to -3.57, p = 0.000) and LVESD (MD = -4.00, 95% CI: -5.50 to -2.50, p = 0.000), as well as a decrease in TNF-α (MD = -7.93, 95% CI: -9.86 to -6.00, p = 0.000), IL-6 (MD = -5.25, 95% CI: -6.59 to -3.92, p = 0.000), IL-18 (MD = -36.07, 95% CI: -46.76 to -25.38, p = 0.000), CRP (MD = -4.41, 95% CI: -6.40 to -2.42, p = 0.000), hs-CRP (MD = -4.90, 95% CI: -5.71 to -4.08, p = 0.000), and an increase in IL-10 (MD = 20.19, 95% CI: 10.42 to 29.97, p = 0.000). In addition, the combination therapy showed enhanced clinical efficacy (OR = 4.08, 95% CI: 3.10 to 5.37, p = 0.000), decreased expression levels of BNP (MD = -138.48, 95% CI: -155.48 to -121.48, p = 0.000), and NT-pro BNP (MD = -315.63, 95% CI: -359.25 to -272.00, p = 0.000), and increased the 6-MWD (MD = 71.02, 95% CI: 57.23 to 84.81, p = 0.000). It is noteworthy that the combination therapy did not lead to an increase in the incidence of adverse reactions (OR = 1.01, 95% CI: 0.68 to 1.50, p = 0.97).

Conclusion: This systematic review and meta-analysis demonstrated the superiority of combining XMLI and CT therapies over CT alone in improving LVR and reducing inflammatory mediators in patients with CHF. Importantly, this combination therapy does not increase adverse reactions. However, it is crucial to exercise caution while interpreting the survey results due to the limited quality of the included studies.

Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=492715, Identifier CRD42023492715.

Keywords: Xinmailong injection; chronic heart failure; inflammation mediators; left ventricular remodeling; meta-analysis; randomized controlled trials; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The PRISMA study flowchart of study search.
FIGURE 2
FIGURE 2
Bias risk assessment of included studies.
FIGURE 3
FIGURE 3
Forest plot for LVEF.
FIGURE 4
FIGURE 4
Forest plot for LVEDD and LVESD. (A) LVEDD. (B) LVESD.
FIGURE 5
FIGURE 5
Forest plot for TNF-α expression levels.
FIGURE 6
FIGURE 6
Forest plot for IL-6 expression levels.
FIGURE 7
FIGURE 7
Forest plot for IL-10 expression levels.
FIGURE 8
FIGURE 8
Forest plot for IL-18 expression levels.
FIGURE 9
FIGURE 9
Forest plot for CRP and hs-CRP expression levels. (A) CRP. (B) hs-CRP.
FIGURE 10
FIGURE 10
Forest plot for clinical efficacy.
FIGURE 11
FIGURE 11
Forest plot for 6-MWD.
FIGURE 12
FIGURE 12
Forest plot for BNP and NT-pro BNP expression levels. (A) BNP. (B) NT-pro BNP.
FIGURE 13
FIGURE 13
Forest plot for adverse reactions.
FIGURE 14
FIGURE 14
The results of sensitivity analysis. (A) LVEF. (B) LVEDD. (C) LVESD. (D) TNF-α. (E) IL-6. (F) IL-10. (G) IL-18. (H) CRP. (I) hs-CRP.
FIGURE 15
FIGURE 15
Egger’s publication funnel plot. (A) LVEF. (B) LVEDD. (C) IL-6. (D) hs-CRP. (E) BNP. (F) NT-pro BNP.
See this image and copyright information in PMC

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