| Objective1.Using speckle tracking imaging to evaluate the effects of Yangyin Shuxin recipe on left ventricular function and left ventricular systolic synchronization in patients with heart failure with ejection fraction retention（heart failure with preserved ejection fraction,HFp EF）.2.Using cardiopulmonary exercise test was used to evaluate the effect of Yangyin Shuxin recipe on HFp EF exercise tolerance.3.To analyze the influencing factors of cardiac function and exercise tolerance in patients with HFp EF in order to provide reference for clinical diagnosis and treatment.Methodsa total of 60 patients with HFp EF included in the first part were randomly divided into treatment group and control group.The control group was treated with routine western medicine.The treatment group was treated with Yangyin Shuxin decoction on the basis of routine treatment of western medicine.The two groups were intervened for 14±3days.General physical examination,information score of four diagnoses of traditional Chinese medicine,Minnesota scale score and BNP test were performed before and14±3 days after treatment.Routine echocardiography,speckle tracking and cardiopulmonary exercise test were evaluated.Results:There was no significant difference in baseline data and pre-treatment efficacy indexes between the two groups（P>0.05）.1.Evaluation of effect（1）After treatment,the treatment group’s information scores(P组内<0.001)and MLHFQ scores(P组内<0.001)were lower than those in the TCM group before treatment.The control group showed no significant changes(P组内=0.773,P组内=0.814).The average difference between the groups after treatment was 9.61 points（95%CI:-14.24～-4.99points,P<0.001）,and the MLHFQ score was 6.19 points（95%CI:-9.15～-3.25 points）.P<0.001).（2）After treatment,the left atrial volume index（LAVI）decreased（P<0.001）,the unwinding rate（UT）increased（P<0.002）,the absolute value of global long axis strain（GLS）increased（P<0.001）,and the standard deviation of left ventricular systolic time（Ts SD16）decreased（P=0.013）in the treatment group,but there was no significant difference in the control group before and after treatment.After treatment,the average changes of LAVI（4.99 ml/m2,95%CI:2.99～7.09ml/m2,P<0.001）,UT（0.14%,95%CI:0.07～0.21%,P<0.001）,GLS（1.08%,95%CI:0.30%～1.85%,P<0.001）and Ts SD16（1.20ms,95%CI:1.13%～1.43ms,P=0.037）of patients in the two groups were statistically significant.（3）BNP in the two groups after treatment was lower than that before treatment,and there was significant difference in the treatment group（P<0.01）,but there was no significant difference in the control group（P>0.05）,and there was no significant difference in the average difference between the two groups after treatment（0.77pg/ml,95%CI:0.48～1.28pg/ml,P=0.327）（4）Exercise tolerance,after treatment Peak VO?（12.49±3.75 to 14.34±3.53ml/min/kg,P<0.001）in the treatment group were significantly higher than those before treatment,while there was no significant statistical difference in the control group Peak VO?（13.12±3.72 to 12.85±2.98ml/min/kg,P=0.663）.After treatment,the average difference of Peak VO?was 1.87ml/min/kg（95%CI:0.59±3.15ml/min/kg,P<0.001）.2.There was no significant difference in blood pressure,heart rate,blood routine,liver and kidney function between the two groups before and after treatment（all P group>0.05 between groups>0.05）,and no adverse events occurred during the study period,and there was no significant difference in blood pressure,heart rate,blood routine,liver and kidney function between the two groups before and after treatment（P<0.05,P>0.05,P>0.05）.3.Correlation analysis of cardiac function and exercise tolerance showed that Peak VO slope was positively correlated with GLS,s’and e’,and negatively correlated with Ts SD6,Elebb and e’,and negatively correlated with slope and e’（r=0.302,0.302 and0.021）.The correlation analysis of cardiac function and exercise tolerance showed that there was a positive correlation between cardiac function and exercise tolerance,and a negative correlation between cardiac function and exercise tolerance,and a negative correlation between cardiac function and exercise tolerance（r=0.271,0.271,0.040,0.002,0.002,0.002,0.002,0.402,0.402,0.402,0.402,0.302,0.302,0.302,0.302,0.302,0.302,0.302,0.302,0.021）.4.Analysis of influencing factors of cardiac function and exercise toleranceThe increase of left ventricular unwinding rate and left ventricular ejection fraction had the greatest influence on the improvement of left atrial volume index,explaining 29.7%of the change of left atrial volume index;the improvement of left ventricular long axis strain and left atrial volume index had the greatest influence on the improvement of Peak VO,explaining 22.5%of the increase of Peak VO.Conclusion:1.Yangyin Shuxin recipe combined with routine western medicine treatment can improve the clinical symptoms,quality of life,increase exercise tolerance,improve left ventricular diastolic and systolic function and left ventricular systolic synchronization in patients with HFp EF,and have good safety.2.Global long axis strain of left ventricle may be a potential index to evaluate cardiac function and exercise tolerance in patients with HFp EF.3.To improve the exercise tolerance of patients with HFp EF,only the effect of improving cardiac function is limited,so multiple intervention measures are needed. |
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