Analysis Of TCM Syndrome Elements Characteristics And Prognosis In Vulnerable Stage Of HFpEF Patients Based On Heart Rate Variability

Objective:1.Compare different overall standard deviation(SDNN)HFp EF patients heart rate difference between physical and chemical indicators,such as echocardiography index,analysis of heart rate variability of each index and physical and chemical indicators,such as echocardiography index correlation and find the clinical factors that affect the heart rate variability.2.Analysis HFp EF patients with TCM syndrome factor distribution characteristics,compare different heart rate overall standard deviation(SDNN)HFp EF TCM syndrome factor distribution of patients.3.To compare different heart rate overall standard deviation(SDNN)HFp EF patients vulnerable period end eents,discussing HFp EF vulnerable period prognosis in patients with risk factors.Methods:HFp EF patients who met the criteria were collected and sorted out for basic admission information,vital signs,biochemical indicators,echocardiographic indicators,and the information of TCM four diagnosis.According to SDNN,HFp EF patients were divided into reduced group(SDNN < 100ms)and non-reduced group(SDNN≥100ms).A database was established and clinical data were recorded.Results:1.Basic clinical featuresThere were 60 cases in SDNN group,including 42 women.There were 56 patients in the reduced SDNN group(43 females).SDNN reduced group had higher heart rate at admission and longer hospital stay,and there were no significant differences in gender composition,age,blood pressure at admission,BMI,smoking and drinking history,past medical history and medication history between the two groups(P>0.05).2.Analysis of frequency distribution characteristics of TCM four-diagnosis information2.1 Analysis results of information frequency of TCM four diagnosisThe top ten symptoms of HFp EF group were chest tightness,wheezing,insomnia,palpitation,choking,dizziness,complexion,dry stools,shortness of breath,and drowsiness.The top ten tongue veins are chord vein,white moss,dull tongue,greasy tongue,yellow tongue,smooth vein,thin tongue,red tongue,fine vein and heavy vein.2.2 Distribution characteristics of TCM syndrome elementsThe weight coefficient of TCM syndromes of HFp EF from high to low is qi deficiency >phlegm turbid > Yin deficiency > blood stasis > Yang deficiency > blood deficiency > Yang hyperactivity > heat accumulation > Qi stagnation > water consumption.The weight coefficients of TCM in SDNN reduction group were qi deficiency > phlegm turbidity > blood stasis > Yin deficiency > Yang deficiency > blood deficiency > Yang hyperactivity > Qi stagnation > heat accumulation > water consumption.The weight coefficients of TCM in SDNN group were qi deficiency > phlegm turbidness > Yin deficiency > Yang deficiency > blood stasis > Yang hyperactivity > heat accumulation > Qi stagnation > water consumption.3.Echocardiographic indicatorsThere was no significant difference in cardiac structure between the two groups(P > 0.05).4.Dynamic ecg indicatorsCompared with SDNN reduce group,SDNN reducing average heart rate,minimum group patients heart rate higher,SDNN,SDANN and SDNNIndex,PNN50,RMSSD is lower and prompted the sympathetic nerve tension higher,parasympathetic nerve tension lower(P < 0.05).There was no statistical significance in arrhythmia among all groups(P > 0.05).5 Physical and chemical IndexesCompared with the reduced SDNN group,HCT and albumin were higher in the nonreduced SDNN group,while e VPS,NLR,FPG and D-DImer were lower,and the differences were statistically significant(P<0.05).HGB,absolute value of neutrophil,absolute value of lymphocyte,ALT,AST,Scr,UA,K,Na,CHO,TG,LDL-C,BNP and other indexes showed no statistical difference between the two groups(P>0.05).6 Correlation analysis6.1 Correlation with baseline dataSDNN was negatively correlated with heart rate(r=-0.313,P=0.001).SDANN was negatively correlated with heart rate(r=-0.348,P=0.000).PNN50 was negatively correlated with heart rate(r=-0.216,P=0.020).SDNNIndex was negatively correlated with heart rate(r =-0.273,P=0.003),and there was no correlation between other indexes and baseline data(P>0.05).6.2 Correlation with physical and chemical indicatorsSDNN was negatively correlated with FPG and D-Dimer(r=-0.267,P=0.004;R =-0.208,P=0.025);RMSSD was negatively correlated with FPG(r=-0.257,P=0.005).PNN50 was negatively correlated with FPG(r=-0.337,P=0.000),SDNNIndex was negatively correlated with FPG(R =-0.253,P=0.006),and there was no correlation between other indexes and physicochemical indexes(P>0.05).6.3 Correlation with ultrasonic indicatorsThere was no significant correlation between HRV index and cardiac ultrasound structural index(P>0.05).SDNN was negatively correlated with A,E/ E ’septum,E/ E’ side and E/ E ’on average(r=-0.196,P=0.035;r= 0.246,P= 0.008;r=0.199,P=0.032;r=-0.226,P=0.015);SDNNIndex was negatively correlated with A(r=-0.209,P=0.024)and positively correlated with E ’profile(r=0.225,P=0.015).RMSSD was negatively correlated with A(r=-0.226,P=0.015)and positively correlated with E/A and E ’partitions(r=0.225,P=0.015;R =0.277,P=0.003);PNN50 was negatively correlated with A(r=-0.213,P=0.022)and positively correlated with E/A,E ’septum and E’ side(r=0.200,P=0.032;R = 0.308,P = 0.001;R =0.213,P=0.022),and there was no correlation among other indicators(P>0.05).7.Influencing factors of heart rate variabilityDifferent E/e ’had a statistically significant difference on SDNN(b=-2.106,T =-2.663,P=0.009),and different heart rate had a statistically significant difference on SDNN(B =-0.604,T =-2.434,P=0.017).There was a statistical difference in the effect of statins on SDNN(b=17.714,T =2.261,P=0.026).Heart rate,statin medication history,and average E/ e’were independent influencing factors of SDNN.8.Prognosis of vulnerability periodDuring the 3-month follow-up,13 patients(11.2%)had a vulnerability end point event,including 10 patients(17.9%)in the reduced SDNN group and 3 patients(5.0%)in the nonreduced SDNN group.There was a statistically significant difference in the rehospitalization rate in the vulnerable period between the two groups(P=0.028).The readmission rate in the SDNN group was 3.57 times higher than that in the non-reduced group,and 2.57 times higher than that in the non-reduced group.9.Risk factors for readmission during vulnerabilitySystolic blood pressure had a statistically significant effect on readmission time(HR=1.032,95%CI 1.008-1.057,P=0.009).SDNN had a statistically significant effect on readmission time(HR=0.966,95%CI 0.065-7.032,P=0.013).Conclusion:1.The TCM syndromes of HFp EF are mainly origin deficiency,deficiency syndrome is mainly qi deficiency and Yin deficiency,and the empirical evidence is mainly phlegm turbidity and blood stasis.2.With the increase of heart rate and the progression of diastolic dysfunction,the impaired autonomic nerve function becomes more serious;Statins protect autonomic nervous function.3.HFp EF patients with high systolic blood pressure and low SDNN at admission were more likely to have adverse cardiovascular events during the vulnerable period.