Herbal medicines for viral myocarditis

Area of Science:

• Cardiology
• Integrative Medicine
• Virology

Background:

• Herbal medicines are explored for treating viral diseases like viral myocarditis.
• Clinical trials exist, but the efficacy of herbal treatments for viral myocarditis remains unestablished.
• This review is an update from a 2012 publication.

Purpose of the Study:

• To evaluate the benefits and harms of herbal medicines in patients with viral myocarditis.
• To assess clinical outcomes (mortality, complications) and indirect outcomes (cardiac function, biochemical markers).
• To include patients of all ages and types of viral myocarditis (acute and chronic).

Main Methods:

• Searched multiple databases (CENTRAL, MEDLINE, EMBASE, LILACS) up to February 2013.
• Included randomized controlled trials (RCTs) of herbal medicines (≥7 days treatment) versus placebo, no intervention, or conventional therapy.
• Included trials comparing herbal medicine plus conventional drug versus drug alone, with adequate allocation sequence generation.

Main Results:

• No new trials were identified; 20 RCTs (2177 participants) from China were included, all with a high risk of bias.
• Astragalus membranaceus injection did not significantly reduce cardiac failure mortality but improved ECG, creatine phosphate kinase (CPK), and lactate dehydrogenase (LDH) levels.
• Shengmai injection and decoction showed significant improvements in ECG, cardiac enzymes (CPK, LDH, CK-MB), and quality of life (SF-36).
• Limited data on adverse events reported no serious effects.

Conclusions:

• No evidence supports herbal medicine's benefit for all-cause mortality in viral myocarditis.
• Some herbal medicines may improve ventricular premature beats, ECGs, myocardial enzyme levels, and cardiac function.
• Findings must be interpreted cautiously due to high risk of bias, small sample sizes, and limited trials per herb.
• Further robust trials are necessary to confirm the efficacy of herbal medicines for viral myocarditis.