Sodium tanshinone ⅡA sulfonate injection as adjunctive therapy for the treatment of heart failure: A systematic review and meta-analysis

Abstract

Background: Sodium tanshinone ⅡA sulfonate (STS) injection has been widely used to treat heart failure over the past years in China. However, to the best of our knowledge, neither systematic review nor meta-analysis on the efficacy of STS injection as adjunctive therapy for heart failure has been reported.

Objective: The aim of this study is to summarize relevant evidence from the published randomized controlled trials (RCTs) to evaluate the efficacy of STS injection as adjunctive therapy for heart failure.

Methods: RCTs on STS injection as adjunctive therapy for the treatment of heart failure were screened from China National Knowledge Infrastructure (CNKI), Wanfang Database, Sino-Med, PubMed, Google Scholar, Medline, China Science and Technology Journal Database (VIP), Chinese Biomedical Literature Database, Cochrane Library, Embase and Chinese Science Citation Database until July 2021. Two authors independently performed the literature searching, data extraction, and quality evaluation. The meta-analysis was carried out by RevMan 5.3. Based on the methodological quality, years of publication, and sample size of the included RCTs, sensitivity analysis and subgroup analysis were investigated.

Results: Fourteen RCTs with a total of 1368 patients were identified in this study. Results from this meta-analysis showed that STS injection as adjunctive therapy was superior to western medicine alone for the treatment of heart failure in improving the total effective rate (RR = 1.23; 95% CI, 1.17 to 1.29; p < 0.00001) and the left ventricular ejection fraction (LVEF; MD = 6.34; 95% CI 5.25 to 7.43; p < 0.00001), meanwhile reducing the left ventricular end-diastolic diameter (LVEDD; MD = -4.79; 95% CI, -6.44 to -3.15; p < 0.00001), left ventricular end-systolic dimension (LVESD; MD = -3.98; 95% CI, -5.79 to -2.17; p < 0.0001) and brain natriuretic peptide (BNP; MD = -118.75; 95% CI, -175.36 to -62.15; p < 0.0001).

Conclusions: This study indicated that STS injection as adjunctive therapy seemed to be more effective than western medicine alone in treating heart failure. However, due to the poor methodological quality of the included RCTs, further well-designed RCTs are required to confirm the efficacy of STS injection.

Keywords: Adjunctive therapy; Heart failure; Meta-analysis; Sodium tanshinone IIA sulfonate injection; Systematic review.