Effect of pueraria on left ventricular remodelling in HFrEF: A systematic review and meta-analysis.

2023-12-04
PloS one 18(12)
- Lipeng Shi
- Lumei Huang
- Erqian Yin
- Jingwei Deng
- Xuqin Du

PubMed: 38048301
DOI: 10.1371/journal.pone.0295344

Study Design

Type: Meta-Analysis
Sample size: n = 911
Population: HFrEF patients
Methods: Meta-analysis of 19 RCTs; combination of pueraria and conventional medicine vs conventional medicine alone

Background

Heart failure with reduced ejection fraction (HFrEF) is a prevalent cardiovascular disease globally, posing a significant burden on healthcare and society. Left ventricular remodelling is the primary pathology responsible for HFrEF development and progression, leading to increased morbidity and mortality. Pueraria, a traditional Chinese herbal medicine and food, is commonly used in China to treat HFrEF. Accumulating evidence suggests that pueraria can effectively reverse left ventricular remodelling in HFrEF patients. This meta-analysis aims to assess the impact of pueraria on left ventricular remodelling in HFrEF patients.

Methods

Eight electronic databases, including PubMed, EMBASE, Clinicaltrials.gov, Cochrane Library, Wanfang, CNKI, CQVIP, and CBM were searched for literature from inception to June 2023. All randomized controlled trials (RCTs) using pueraria in the treatment of HFrEF were included. The Cochrane Risk of Bias tool was utilized for RCTs' methodological evaluation, while Review Manager 5.4.1 was used to analyze the data.

Results

Nineteen RCTs with a total of 1,911 patients (1,077 males and 834 females) were identified. Meta-analysis indicated that combination medication of pueraria and conventional medicine (CM) was superior to the CM alone in raising left ventricular ejection fraction (LVEF; MD = 6.46, 95% CI, 4.88 to 8.04, P < 0.00001), and decreasing left ventricular end-diastolic diameter (LVEDD; MD = -4.78, 95% CI, -6.55 to -3.01, P < 0.00001), left ventricular end-Systolic diameter (LVESD; MD = -3.98, 95% CI, -5.98 to -1.99, P < 0.00001) and N-terminal pro-brain natriuretic peptide (NT-proBNP; MD = -126.16, 95% CI, -185.30 to -67.03, P < 0.0001). Besides, combination medication improved clinical efficacy rate (RR = 3.42, 95% CI, 2.54 to 4.59, P < 0.00001), 6-min walk test (6-MWT; MD = 65.54, 95% CI, 41.77 to 89.31, P < 0.00001), and TCM syndrome score efficacy (RR = 3.03, 95% CI, 1.57 to 5.83, P = 0.0009). Regarding safety, no difference was observed for adverse events (RR = 0.59, 95% CI, 0.22 to 1.54, P = 0.28).

Conclusion

The use of pueraria combined with conventional medicine in HFrEF patients has superiority over conventional medicine alone in ameliorating cardiac function and reversing left ventricular remodeling. Moreover, combination medication has no increase in adverse drug events. Given some limitations, more prudence and high-quality clinical trials are needed in the future to verify the conclusions.

Research Insights

Pueraria→Decreased Left Ventricular End-Systolic Diameter
Meta-analysis indicated that combination medication of pueraria and conventional medicine (CM) was superior to the CM alone in ... decreasing left ventricular end-Systolic diameter (LVESD; MD = -3.98, 95% CI, -5.98 to -1.99, P < 0.00001)
Effect
Beneficial
Effect size
Moderate
Pueraria→Improved 6-Minute Walk Test Distance
Besides, combination medication improved ... 6-min walk test (6-MWT; MD = 65.54, 95% CI, 41.77 to 89.31, P < 0.00001)
Effect
Beneficial
Effect size
Moderate
Pueraria→Improved Clinical Efficacy Rate
combination medication improved clinical efficacy rate (RR = 3.42, 95% CI, 2.54 to 4.59, P < 0.00001)
Effect
Beneficial
Effect size
Large
Pueraria→Improved Left Ventricular Ejection Fraction
Meta-analysis indicated that combination medication of pueraria and conventional medicine (CM) was superior to the CM alone in raising left ventricular ejection fraction (LVEF; MD = 6.46, 95% CI, 4.88 to 8.04, P < 0.00001)
Effect
Beneficial
Effect size
Large
Pueraria→Improved Six-Minute Walk Test
combination medication improved ... 6-min walk test (6-MWT; MD = 65.54, 95% CI, 41.77 to 89.31, P < 0.00001)
Effect
Beneficial
Effect size
Large
Pueraria→Improved TCM Syndrome Score
combination medication improved ... TCM syndrome score efficacy (RR = 3.03, 95% CI, 1.57 to 5.83, P = 0.0009)
Effect
Beneficial
Effect size
Large
Pueraria→Increased Left Ventricular Ejection Fraction
Meta-analysis indicated that combination medication of pueraria and conventional medicine (CM) was superior to the CM alone in raising left ventricular ejection fraction (LVEF; MD = 6.46, 95% CI, 4.88 to 8.04, P < 0.00001)
Effect
Beneficial
Effect size
Moderate
Pueraria→Reduced Left Ventricular End-Diastolic Diameter
Meta-analysis indicated that combination medication of pueraria and conventional medicine (CM) was superior to the CM alone in ... decreasing left ventricular end-diastolic diameter (LVEDD; MD = -4.78, 95% CI, -6.55 to -3.01, P < 0.00001)
Effect
Beneficial
Effect size
Large
Pueraria→Reduced Left Ventricular End-Systolic Diameter
Meta-analysis indicated that combination medication of pueraria and conventional medicine (CM) was superior to the CM alone in ... decreasing left ventricular end-Systolic diameter (LVESD; MD = -3.98, 95% CI, -5.98 to -1.99, P < 0.00001)
Effect
Beneficial
Effect size
Large
Pueraria→Reduced N-terminal Pro-brain Natriuretic Peptide Level
Meta-analysis indicated that combination medication of pueraria and conventional medicine (CM) was superior to the CM alone in ... decreasing ... N-terminal pro-brain natriuretic peptide (NT-proBNP; MD = -126.16, 95% CI, -185.30 to -67.03, P < 0.0001)
Effect
Beneficial
Effect size
Large

Adverse Events Reported

Pueraria→Overall tolerability
Regarding safety, no difference was observed for adverse events (RR = 0.59, 95% CI, 0.22 to 1.54, P = 0.28).
Finding
No significant difference
Magnitude
RR = 0.59, 95% CI 0.22 to 1.54, P = 0.28
Significant
No