Traditional Chinese Medicine With Warming Yang For Diuresis For Patients With Chronic Heart Failure: A Systematic Review

Objective:To evaluate the efficacy and safety of compound Traditional Chinese Medicine with warming yang for diuresis for patients with chronic heart failure.Methods:According to the methods of systematic review recommended by the Cochrane Collaboration,we collected the randomized controlled trials (RCTs)about warming yang for diuresis for patients with chronic heart failure through the electronic and manual search, and the deadline was December 2010, Two reviewers selected studies, assess quality of studies, and studies,extracted data independently. Meta-analysis was to be performed with the Revman5.0.25.Results:Thirty-one trials involving 2414 patients were included, all of which were none placebo controlled trials(open controlled trials). There was no evidence provided by these present trials to demonstrate that compound Traditional Chinese Medicine of warming yang for diuresis could have long-term effect for patients with chronic heart failure.These 31 trials included assessed the effective rate, or BNP, or 6MWT, or cardiac function index at the end of treatment. Meta-analysis were performed with different assessment above, the results could be divided into two parts, which were as following. (1) The results favored treatment group. Twenty-nine trials used improvement of cardiac function (OR 3.81,95%CI 3.04 to 4.77), five trials used improvement of TCM symptom (OR 4.24,95%CI2.19 to 8.19), three trials used 6-minute walking test(6MWT) (MD 60.76,95%CI 40.66 to 80.87), seventeen trials used left ventricular ejection fraction (LVEF) (MD 0.06,95%CI 0.05 to 0.08), two trials used indicators of left ventricular fractional shortening(FS) (MD 2.87,95%CI 0.90 to 4.84), five trials used stroke volume(SV) (MD=6.81,95%CI 2.38 to 11.25), five trials used cardiac output (CO) (MD 0.49,95%CI 0.29 to 0.69). Three trials used BNP (MD-98.85,95%CI -128.29 to -69.41), three trials used left ventricular end diastolic diameter(LVEDD) (MD 6.53,95% CI -9.03 to -4.02), three trials used left ventricular end systolic volume(LVESV) (MD-8.10,95%CI-14.27 to-1.93).(2)There was no statistic difference between treatment and control groups. Three trials used left ventricular end diastolic volume (LVEDV) (MD-7.24,95%CI-16.59 to 2.12),four trials used E/A (MD 0.15,95%CI-0.08 to 0.37), three trials used cardiac index(CI)(MD 0.56,95%CI 0.00 to 1.12).Nine trials reported adverse events, of which five trials did not mention any AEs. Four trails referred to the adverse events, where 3 trials definitely reported AEs were caused by these medicine, one trial reported AEs existed in ite control group. So there was no enough evidence to reveal the AEs of Traditional Chinese Medicine with warming yang for diuresis, and the safty need to be studied further.Conclusion:The compound Traditional Chinese Medicine with warming yang for diuresis could improve cardiac function and TCM symptom, increase the numeral value of 6-minute walking test, left ventricular ejection fraction, cardiac output,stroke volume, and indicators of left ventricular fractional shortening, reduce the numeral value of BNP, left ventricular end systolic volume, and left ventricular end diastolic diameter for CHF in a short period. But its effects on the long-term prognosis of patients with CHF and the safty still need to be confirmed by more RCTs with high quality.