Shenmai injection in treating chemotherapy-related cardiotoxicity of breast cancer: a systematic review and meta-analysis

Abstract

Objective

Shenmai injection (SMI) is an established treatment for cardiac diseases, and we performed to evaluate the efficacy of SMI combined with chemotherapy drugs for the treatment of chemotherapy-induced cardiotoxicity.

Methods

The primary outcome was abnormal electrocardiogram (ECG), left ventricular ejection fraction (LVEF) and E/A. The secondary outcomes included myocardial injury biomarkers (creatine kinase [CK], creatine kinase MB [CK-MB], and cardiac troponin I [cTnI]) and lipid peroxide markers (superoxide dismutase [SOD], glutathione [GSH], and malondialdehyde [MAD]).

Results

Studies indicated that SMI combined with chemotherapy drugs has advantages over chemotherapy drugs alone in reducing the incidence of abnormal ECG (ST-T: RR = 0.613, 95% CI [0.437, 0.862], P = 0.005; extrasystole: RR = 0.527, 95% CI [0.349, 0.798], P = 0.002). Myocardial injury biomarkers in the experimental group were lower than those in the control group (CK: SMD = –2.614, 95% CI [–3.156, –2.071], P = 0.000; CK-MB: SMD = –6.882, 95% CI [–8.982, –4.782], P = 0.000; cTnI: SMD = –3.610, 95% CI [–4.949, –2.271], P = 0.000). Ultrasonic cardiogram analysis showed that the experimental group had a higher LVEF and E/A than the control group (LVEF: SMD = 1.572, 95% CI [1.176, 1.969], P = 0.000; E/A: SMD = 0.280, 95% CI [0.153, 0.407], P = 0.000). Lipid peroxide meta-analysis showed that the experimental group had higher SOD and GSH levels (SOD: weighted mean difference (WMD) = 39.783, 95% CI (32.524, 47.042), P = 0.000; GSH: WMD = 32.960, 95% CI [26.055, 39.865], P = 0.000), and lower malondialdehyde (MDA) (WMD = –4.962, 95% CI [–6.041, –3.883], P = 0.000).

Conclusion

SMI is effective in reducing cardiac injury and the incidence of cardiotoxicity.