Key result
Shenmai injection combined with chemotherapy significantly reduced the incidence of abnormal ST-T ECGs compared to chemotherapy alone (RR 0.613; 95% CI 0.437-0.862; P=0.005).
Why the study?
Shenmai injection is an established cardiac treatment, but its efficacy combined with chemotherapy drugs for chemotherapy-induced cardiotoxicity required evaluation.
Does Shenmai injection combined with chemotherapy reduce chemotherapy-induced cardiotoxicity in breast cancer patients?
Systematic Review
Does Shenmai injection combined with chemotherapy reduce chemotherapy-induced cardiotoxicity in breast cancer patients?
Relative Risk: 0.613 (95% CI 0.437–0.862)
p-value: p=0.005
Shenmai injection combined with chemotherapy may be effective in reducing cardiac injury and the incidence of cardiotoxicity in breast cancer patients.
Supports adjunctive Shenmai to reduce cardiotoxicity in breast cancer chemotherapy; extends meta-analytic evidence on ECG markers.
Shenmai injection (SMI) is an established treatment for cardiac diseases, and we performed to evaluate the efficacy of SMI combined with chemotherapy drugs for the treatment of chemotherapy-induced cardiotoxicity. The primary outcome was abnormal electrocardiogram (ECG), left ventricular ejection fraction (LVEF) and E/A. The secondary outcomes included myocardial injury biomarkers (creatine kinase [CK], creatine kinase MB [CK-MB], and cardiac troponin I [cTnI]) and lipid peroxide markers (superoxide dismutase [SOD], glutathione [GSH], and malondialdehyde [MAD]). Studies indicated that SMI combined with chemotherapy drugs has advantages over chemotherapy drugs alone in reducing the incidence of abnormal ECG (ST-T: RR = 0.613, 95% CI [0.437, 0.862], P = 0.005; extrasystole: RR = 0.527, 95% CI [0.349, 0.798], P = 0.002). Myocardial injury biomarkers in the experimental group were lower than those in the control group (CK: SMD = –2.614, 95% CI [–3.156, –2.071], P = 0.000; CK-MB: SMD = –6.882, 95% CI [–8.982, –4.782], P = 0.000; cTnI: SMD = –3.610, 95% CI [–4.949, –2.271], P = 0.000). Ultrasonic cardiogram analysis showed that the experimental group had a higher LVEF and E/A than the control group (LVEF: SMD = 1.572, 95% CI [1.176, 1.969], P = 0.000; E/A: SMD = 0.280, 95% CI [0.153, 0.407], P = 0.000). Lipid peroxide meta-analysis showed that the experimental group had higher SOD and GSH levels (SOD: weighted mean difference (WMD) = 39.783, 95% CI (32.524, 47.042), P = 0.000; GSH: WMD = 32.960, 95% CI [26.055, 39.865], P = 0.000), and lower malondialdehyde (MDA) (WMD = –4.962, 95% CI [–6.041, –3.883], P = 0.000). SMI is effective in reducing cardiac injury and the incidence of cardiotoxicity.
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Feng et al. (2024) conducted a systematic review in Chemotherapy-related cardiotoxicity of breast cancer. Shenmai injection combined with chemotherapy drugs vs. Chemotherapy drugs alone was evaluated on Abnormal electrocardiogram (ECG), left ventricular ejection fraction (LVEF) and E/A (RR 0.613, 95% CI 0.437, 0.862, p=0.005). Shenmai injection combined with chemotherapy significantly reduced the incidence of abnormal ST-T ECGs compared to chemotherapy alone (RR 0.613; 95% CI 0.437-0.862; P=0.005).
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