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Intervention Review

Herbal medicines for viral myocarditis

  1. Zhao Lan Liu1,
  2. Zhi Jun Liu1,
  3. Jian Ping Liu1,*,
  4. Joey SW Kwong2

Editorial Group: Cochrane Heart Group

Published Online: 14 NOV 2012

Assessed as up-to-date: 16 JUN 2011

DOI: 10.1002/14651858.CD003711.pub4

How to Cite

Liu ZL, Liu ZJ, Liu JP, Kwong JSW. Herbal medicines for viral myocarditis. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD003711. DOI: 10.1002/14651858.CD003711.pub4.

Author Information

  1. 1

    Beijing University of Chinese Medicine, Centre for Evidence-Based Chinese Medicine, Beijing, China

  2. 2

    The Chinese University of Hong Kong, Division of Cardiology & Heart Education And Research Training (HEART) Centre, Department of Medicine and Therapeutics, Prince of Wales Hospital, & Institute of Vascular Medicine, Shatin, New Territories, Hong Kong

*Jian Ping Liu, Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, 100029, China. jianping_l@hotmail.com. jianping@fagmed.uit.no.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 14 NOV 2012

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This is not the most recent version of the article. View current version (28 AUG 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Herbal medicines are being used as a treatment for viral diseases such as viral myocarditis and numerous clinical trials have been conducted to investigate their efficacy. Despite this wealth of evidence, the role of herbal medicines in the treatment of viral myocarditis is yet to be established. This is an update of the review published in 2010.

Objectives

To assess the effects of herbal medicines on clinical (for example mortality, incidence of complications) and indirect outcomes (for example cardiac function, biochemical response) in patients with viral myocarditis.

Search methods

We searched CENTRAL (The Cochrane Library 2011, Issue 2), MEDLINE (January 1966 to June 2011), EMBASE (January 1998 to June 2011), Chinese Biomedical Database (1979 to 2011), China National Knowledge Infrastructure (1979 to 2011), Chinese VIP Information (1989 to 2011), Chinese Academic Conference Papers Database and Chinese Dissertation Database (1980 to 2011), AMED (June 2011), LILACS (June 2011), and the Cochrane Complementary Medicine Field Trials Register. We handsearched Chinese journals and conference proceedings. No language restrictions were applied.

Selection criteria

Randomised controlled trials of herbal medicines (with a minimum of seven days treatment duration) compared with placebo, no intervention, or conventional interventions were included. Trials of herbal medicine plus conventional drug versus drug alone were also included. Only trials that reported an adequate description of allocation sequence generation were included.

Data collection and analysis

Two review authors independently extracted data and evaluated trial quality. Adverse effects information was collected from the trials.

Main results

Twenty randomised controlled trials involving 2177 people were included. All trials were conducted and published in China. The controls included anti-arrhythmic drugs, corticosteroids, and antiviral therapies such as ribavirin or interferon. Combining the risk of bias on random sequence generation, allocation concealment, selective reporting, and incomplete outcome data, the included trials were assessed to be at high risk of bias. Thirteen different herbal medicines were tested in the included trials. None of the trials reported outcomes on mortality. The trials reported electrocardiogram results, level of myocardial enzymes, cardiac function, and adverse effects.

A meta-analysis showed a significant effect of Astragalus membranaceus injection plus supportive therapy on the number of patients with an abnormal electrocardiogram (RR 0.28, 95% CI 0.13 to 0.61), ST-T changes (RR 0.72, 95% CI 0.54 to 0.95), creatine phosphate kinase (CPK) levels (MD -21.54, 95% CI -33.80 to -9.28), and lactate dehydrogenase (LDH) levels (MD -30.33, 95% CI -46.78 to -13.88).

Shengmai injection plus supportive therapy showed a significant effect on the number of patients with an abnormal electrocardiogram (RR 0.11, 95% CI 0.01 to 0.86), CPK levels (MD -103.90, 95% CI -114.97 to -92.83), LDH levels (MD -34.60, 95% CI -51.25 to -17.95), and on myocardial enzyme CK-MB levels (MD -10.87, 95% CI -14.50 to -7.24). Shengmai decoction plus supportive therapy showed a significant effect on improving quality of life measured by the SF-36 (MD 40.20, 95% CI 18.13 to 62.27) compared to supportive therapy. Data on adverse events were only available from six of the included trials and no serious adverse effects were reported.

Authors' conclusions

Some herbal medicines may lead to improvement of ventricular premature beat, electrocardiogram, level of myocardial enzymes, and cardiac function in viral myocarditis. However, these findings should be interpreted with care due to the high risk of bias of the included studies, small sample size, and limited number of trials on individual herbs. Further robust trials are needed to explore the use of herbal medicines in viral myocarditis.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

Herbal medicines for viral myocarditis

Viral myocarditis is a disease where the muscles in the walls of the heart become infected with a virus. This systematic review evaluated the effect of various herbal formulations (including single herbs, extract, and mixtures of different herbs) for treating acute and chronic viral myocarditis patients. The control interventions included anti-arrhythmic drugs, corticosteroids, and antiviral therapies such as ribavirin or interferon. Twenty identified clinical trials involving 2177 people were performed and published in China. The review of trials found that Astragalus membranaceus (either as an injection or granules) may have a positive effect on improving cardiac function including abnormal electrocardiogram and ST-T changes. Shengmai decoction triggered significant improvement in quality of life measured by the SF-36. Data on adverse events were only available from six trials. No serious adverse effects were reported. The methodological quality of the clinical trials evaluating these herbal medicines was generally poor. All 20 trials had adequate sequence generation and four provided information on how the allocation sequence was concealed. Nineteen trials did not provide information about blinding and 19 addressed incomplete outcome data. Eight of the 20 trials were judged to be at high risk of bias for selective reporting.