Effect of traditional Chinese medicine on anthracycline-induced cardiotoxicity in animal models: A systematic review and meta-analysis

To evaluate the effect of traditional Chinese medicine (TCM) on anthracycline-induced cardiotoxicity (AIC) in animal models. Separate systematic searches for preclinical studies were performed in the PubMed, EMBASE, Web of Science, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, Chinese Scientific Journal Database, and Wanfang Data from inception to August 2019. The primary outcomes were echocardiography, serum assays for myocardial enzymograms, histological assessments, and electrocardiograms. The secondary outcomes mainly included body weight and safety evaluations. The protocol is registered on PROSPERO (CRD42019145819). RevMan (V.5.3) was used for meta-analysis. We identified 10 studies from 9 international scientific publications describing the efficacy of TCM on AIC animal models. All the included studies reported that, compared with animal model without any intervention, TCM significantly improved ventricular function, cardiac biomarkers, electrocardiograph results, and cardiac fibrosis. Improved survival rates and body mass indices were also observed with TCM. We further pooled the available data from four studies (63 animals) for the meta-analysis and the results showed that, compared with models without any intervention, TCM significantly increased the ejection fraction by 14.13% (95% CI, 9.96–18.29) and fraction shortening by 8.66% (95% CI, 6.05–11.26). Creatine kinase-MB (SMD = −2.49, 95% CI: −3.12 to −1.85) and lactate dehydrogenase (SMD = −2.78, 95% CI: −3.45 to −2.12) were also significantly decreased by TCM. TCM is effective in improving AIC in animal models and has tremendous potential to be translated to treat AIC in clinical practice. Additionally, the systematic review and meta-analysis of animal experiments may be valuable in enhancing and guiding animal experiments and promoting the transformation of the results.