Cheng Wanru, Wang Jing, Sun Jie
Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Front Pharmacol. 2025 Jul 25;16:1544121. doi: 10.3389/fphar.2025.1544121. eCollection 2025.
The aim of this study is to summarize and evaluate the quality of evidence regarding the effectiveness and safety of different interventions for patients with cardiomyopathy, based on published meta-analyses through an umbrella review.
The literature was searched via PubMed, Embase, Web of Science, and the Cochrane Library. Two reviewers evaluated the methodological quality of the included articles using the AMSTAR score. In addition, according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), evidence of each outcome was evaluated and graded as "high," "moderate," "low," or "very low" quality for drawing conclusions. Additionally, each outcome was classified into four categories (classes I-IV and nonsignificant).
High-quality evidence suggested that for patients with cardiomyopathy, stem cell treatment could significantly improve left ventricular ejection fraction (LVEF), left ventricular ejection volume, 6-min walk distance (6-MWD), and New York Heart Association (NYHA) functional classification. High-quality evidence also suggested that for patients with dilated cardiomyopathy (DCM), adding traditional Chinese medicines (TCMs) such as Qili Qiangxin capsule (QQC), Shenmai injection (SMI), Zhigancao, and Shengmai to conventional Western medical treatment could significantly improve clinical effects, including LVEF, 6-MWD, and reductions in inflammatory indicators, left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), and heart rate. In addition, high-quality evidence suggested that for patients with DCM, drugs such as atorvastatin, carvedilol, thyroid hormone, and L-carnitine could significantly improve LVEF and cardiac output and reduce C-reactive protein levels, systolic blood pressure, LVEDD, and left ventricular end-diastolic and end-systolic volumes. Furthermore, implantable cardioverter defibrillator (ICD) therapy could significantly reduce sudden cardiac death.
High-quality evidence showed that cell therapy, atorvastatin, carvedilol, and thyroid hormone have significant improvement effects on the prognosis of cardiomyopathy. In addition, combining traditional Chinese medicines with conventional Western medicine therapy could significantly improve the effectiveness of conventional Western medicine therapy for cardiomyopathy.
本研究旨在通过一项伞状综述，基于已发表的荟萃分析，总结并评估不同干预措施对心肌病患者有效性和安全性的证据质量。
通过PubMed、Embase、Web of Science和Cochrane图书馆检索文献。两名评价者使用AMSTAR评分评估纳入文章的方法学质量。此外，根据推荐分级、评估、制定与评价（GRADE），对每个结局的证据进行评估，并分级为“高”、“中”、“低”或“极低”质量，以便得出结论。此外，每个结局分为四类（I-IV类和无显著差异）。
高质量证据表明，对于心肌病患者，干细胞治疗可显著改善左心室射血分数（LVEF）、左心室射血量、6分钟步行距离（6-MWD）和纽约心脏协会（NYHA）功能分级。高质量证据还表明，对于扩张型心肌病（DCM）患者，在传统西医治疗基础上加用中药，如芪苈强心胶囊（QQC）、参麦注射液（SMI）、炙甘草、生脉，可显著改善临床疗效，包括LVEF、6-MWD，以及降低炎症指标、左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）和心率。此外，高质量证据表明，对于DCM患者，阿托伐他汀、卡维地洛、甲状腺激素和L-肉碱等药物可显著改善LVEF和心输出量，并降低C反应蛋白水平、收缩压、LVEDD以及左心室舒张末期和收缩末期容积。此外，植入式心律转复除颤器（ICD）治疗可显著降低心源性猝死。
高质量证据表明，细胞治疗、阿托伐他汀、卡维地洛和甲状腺激素对心肌病预后有显著改善作用。此外，中药与传统西医治疗相结合可显著提高传统西医治疗心肌病的有效性。
