Analysis Of Clinical Features Of Chronic Heart Failure Combined With Atrial Fibrillation Based On Syndrome Elements

Background:Chronic heart failure (hereinafter referred to as heart failure) is due to any reason, the initial myocardial injury, caused by changes in cardiac structure and (or) function, and finally lead to poor heart pumping and(or) filling functions is a common clinical disease. Heart failure is a progressive disease, its development process can be complicated by the different types of arrhythmias, including atrial fibrillation (hereinafter referred to as Af), the most common and prognosis,it can also merge other types of arrhythmias such as premature ventricular beats, ventricular tachycardia and so on. According to the available data indicate that the incidence of heart failure patients with atrial fibrillation is40.6%. The changes of hemodynamics of the heart due to the occurrence of atrial fibrillation will increase the incidence of vascular thrombotic events, and continuous rapid atrial fibrillation can cause tachycardia cardiomyopathy, and above all seriously affect the quality of life and prognosis of patients with heart failure.Western medicine, the aim of treatment of Af is maintenance of sinus rhythm, control the ventricular rate and prevent the occurrence of thromboembolic events. However, because of possible adverse reactions of treatment or medication, there are some limitations in the treatment of atrial fibrillation. Because of its more stable clinical effect and no significant adverse reactions, Chinese traditional medicine for the treatment of atrial fibrillation get more and more attention.Objective:Though the analysis of the clinical features with Af,and the subgroups which grouped based on syndrome factors in order to make clinical treatment more targeted, thereby enhancing the quality of life and survival rate of patients with chronic heart failure,Methods:Retrospective analysis of clinical features of195patients with chronic heart failure, all patients are coronary heart disease as the primary disease, NYHA functional classification in grade II-IV. All patients are meet the standards as with BNP>900pg/ml or cardiac color Doppler ultrasound diagnosis of LVEF<50%. All the patients were divided into the Af group (n=62) and non-Af group (n=133) through the ECG shows he's Af or not. Comparing the two groups of history characteristics, clinical biochemical indicators of cardiac structure, function and the clinical features under different syndrome factors.Results:1. General Information:There is no difference in age, gender distribution,and the syndrome factors distribution between the Af group and the non-Af group.(p>0.05).2. History characteristics:The incidence of hypertension is higher in the Af group, the incidence of diabetes and hyperlipidemia are higher in the non-Af group.3. Cardiac function:To compare the Af group with the non-Af group. The difference of NYHA class between the two groups was statistically significant (p<0.05), and the NYHA class of the Af group is higher. Comparison of BNP between the two groups, it is higher in the Af group, but the difference between the two groups was not statistically significant (p>0.05). Comparison of the LVEF between the two groups, it is higher in the Af group, and the difference between the two groups is statistically significant (p <0.05).4. Biochemical indicators:Comparison of the electrolyte between the two groups the difference was not statistically significant (p>0.05). The comparison between the two groups in serum total bilirubin, direct bilirubin, indirect bilirubin difference was statistically significant (p<0.01), and are higher in Af group. And comparing all patients with serum bilirubin level and cardiac structure found that there is correlation between them (p<0.01). Comparison of lipid levels between the two groups,the Af group with the lower level of total cholesterol, LDL, VLDL and triglyceride than non-Af group, and all the differences are statistically significant (p<0.01). High-density lipoprotein of the AF group is higher than non-Af group, but the difference was not statistically significant (p>0.05).5. Cardiac structure:To compare the heart of the structure of the Af group and the non-Af group found that the LVEDD of Af group is lower than that of non-atrial fibrillation.The LAD and RAD of Af group are higher than those of non-Af group. All the differences above are ststistically significant(p<0.05). The IVS and the LVPW of Af group are both higher than those of non-Af group, but the difference was not statistically significant (p>0.05).6. Heart valvular regurgitation:Compared the integral of the valvular regurgitation between the two groups. The integral of tricuspid regurgitation, aortic regurgitation and pulmonary regurgitation of the Af group is higher than that of the non-Af group,and the differences are statistically significant (p<0.01).7. Different syndrome factors in patients with clinical features of impact7.1Between heart failure patients with atrial fibrillation of different syndrome factors:the differences in the BNP, LVEDD and the mitral regurgitation of the two groups were statistically significant (p<0.05), and all the changes are worse in the yang deficiency Group7.2The clinical features of different syndrome factors subgroups Af group and the non- Af group:7.2.1Qi Deficiency Group:The NYHA class, prevalence of hypertension, serum total bilirubin, direct bilirubin, left atrial diameter, right atrial diameter, right ventricular diameter, LVEF, FS, the integral of tricuspid regurgitation, pulmonary regurgitation of Af group are higher than those of the non-Af group(P<0.05). The total cholesterol, LDL, serum VLDL, serum triglyceride, BNP, left ventricular end-diastolic of Af group were lower than non-Af group (P<0.05).7.2.2Xue Deficiency Group:Right atrial diameter of Af group is higher than that of the non-Af group (P<0.05).7.2.3Yang Deficiency Group:BNP, left atrial diameter, right atrial diameter, the integral of mitral regurgitation, tricuspid regurgitation, pulmonary regurgitation, aortic regurgitation of Af group are higher than the non-Af group (P<0.05).7.2.4Yin Deficiency Group:NYHA class, prevalence of hypertension, LVEF, FS, the integral of tricuspid regurgitation of Af group are higher than non-Af group (P<0.05). The serum total cholesterol, LDL, serum VLDL, serum triglycerides, LVEDD of Af group were lower than non-Af group (P<0.05).7.2.5the Stasis Group:the prevalence of diabetes, serum total bilirubin, direct bilirubin, serum bilirubin, right atrial diameter, LVEF, FS, the integral of tricuspid regurgitation, pulmonary regurgitation of Af group are higher than non-Af group (P<0.05). Hyperlipidemia prevalence of atrial fibrillation group, serum total cholesterol, LDL, serum VLDL, serum triglycerides, LVEDD were lower than non-Af group (P<0.05).7.2.6the Phlegm Group:NYHA class, prevalence of hypertension, serum total bilirubin, direct bilirubin, serum bilirubin, left atrial diameter, right atrial diameter, the integral of tricuspid regurgitation, pulmonary regurgitation of Af group are higher than non-Af group (P<0.05). Hyperlipidemia prevalence of atrial fibrillation group, serum total cholesterol, LDL, and serum very low density lipoprotein cholesterol, serum triglycerides, were lower than non-Af group (P<0.05).Conclusion:1. Patients with chronic heart failure, the patients with hypertension have the higher the incidence of Af.The patients with diabetes mellitus, hyperlipidemia have the lower incidence of Af.2. Heart failure combined Af patients with poor cardiac function, mainly reflected in the different symptoms (NYHA).3. Heart failure combined Af have the higher level of serum bilirubin,but the lower level of lipid. 4. Patients with Af are more prone to changes in cardiac structures, especially atrial structural changes in the main, and accompanied with heart valvular regurgitation. Late in the disease progression, the main syndrome factor is yang deficiency and the emergence of obvious cardiac structure and function of the change.5. Qi deficiency and Yin deficiency group mainly differences in lipid and(or) serum bilirubin levels. Yang deficiency performance differences in cardiac structure and function. Blood stasis and phlegm have the differences in serum bilirubin, serum lipid levels, cardiac structure and function.