Study On The Distribution Of TCM Syndrome Types In Chronic Heart Failure Stage B And The Correlation With Cardiac Function Indicators

ObjectiveChronic heart failure stage B belongs to the pre-clinical stage of heart failure.In order to delay the progress of heart failure,early,safe and effective clinical intervention should be carried out for patients with chronic heart failure stage B.To study the distribution of TCM syndromes in patients with chronic heart failure(CHF)in stage B and their relationship with complications,left ventricular ejection fraction(LVEF),plasma brain natriuretic peptide(BNP),diastolic function index(E/A,E/E'),and summarize the characteristics of TCM syndromes in patients with CHF in stage B,so as to provide reference for clinical prevention and treatment of CHF.MethodsSelected patients who met the inclusion criteria in the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine from November 2013 to February 2019.Record the basic information of patients,combined diseases,four diagnostic data,cardiac color Doppler ultrasound results(LVEF,E/A,E/E',etc.),laboratory results(BNP,etc.)and construct the TCM syndrome types and information database of chronic heart failure stage B.Supported by SPSS 25.0 software,the characteristics of TCM syndrome differentiation and typing in stage B of chronic heart failure were analyzed statistically.Results1.The average age of 100 patients with chronic heart failure in stage B was 57.29 years,and the age of onset group was concentrated in 50-69 years.The prevalence of AHF was 4.55:1 in males and females,and the majority of the patients were males.Distribution of diseases in patients with chronic heart failure stage B included 51 cases of hypertension,51 cases of coronary heart disease,34 cases of diabetes mellitus,19 cases of dyslipidemia,12 cases of atrial fibrillation and 9 cases of dilated cardiomyopathy.The average age of patients with chronic heart failure stage B complicated with coronary heart disease and without coronary heart disease was 60.04 years old and 54.43 years old,respectively,with significant difference between the two ages(P=0.036<0.05).2.The single TCM syndromes of chronic heart failure in stage B were Qi deficiency syndrome(75 cases,37.5%),followed by blood stasis syndrome(53 cases,26.5%),phlegm turbidity syndrome(51 cases,25.5%),Yang deficiency syndrome(12 cases,6.0%)and yin deficiency syndrome(9 cases,4.5%).The most common syndromes in this group were Qi deficiency and blood stasis syndrome(28 cases)and Qi deficiency and phlegm turbidity syndrome(28 cases),accounting for 28%respectively,followed by phlegm and blood stasis syndrome(23%),Qi Yang deficiency syndrome(12%),Qi Yin deficiency syndrome(7%)and Yin deficiency and blood stasis syndrome(2%).3.In this group,the LVEF values of patients with chronic heart failure stage B were mainly concentrated in 40%-49%,accounting for 66%of the total sample.Among the patients with diastolic dysfunction in stage B of chronic heart failure,52 had E/A<1,75 had E/E'>8,34 had E/A>1 and 25 had E/E'<8.The mean value of LVEF in E/E'>8 group was lower than that in E/E'?8 group.The standard deviations of the mean value of LVEF in two groups were 41.04±6.44,44.24±5.18,respectively,and the difference between the two groups was significant(P=0.027<0.05).The mean value of LVEF in group E/A<1 was lower than that in group E/A>1,but there was no significant difference between the two groups(P=0.593>0.05).There was no significant difference in LVEF and plasma BNP of combined syndromes(P>0.05).4.According to Spearman rank correlation analysis,there was a negative correlation between plasma BNP value and LVEF value in patients with chronic heart failure stage B(r=-0.227),but the correlation coefficient between them was not significant(P=0.113>0.05).There was a positive correlation between ejection fraction and E/A ratio of diastolic dysfunction in patients with chronic heart failure stage B(r=0.069),but there was no significant difference in correlation coefficient between them(P=0.527>0.05).There was a negative correlation between ejection fraction and E/E' ratio of diastolic dysfunction in patients with chronic heart failure in stage B(r=-0.280),and the correlation coefficients were statistically significant(P=0.005<0.01)·Conclusion1.The TCM syndromes of patients with chronic heart failure in stage B are characterized by deficiency and excess,deficiency of qi,blood stasis and phlegm turbidity.Qi deficiency syndrome,blood stasis syndrome and phlegm turbidity syndrome are the most common basic TCM syndromes in stage B of chronic heart failure.The combined TCM syndromes are Qi deficiency and blood stasis syndrome,Qi deficiency and phlegm turbidity syndrome,phlegm and blood stasis syndrome are common,but Qi Yang deficiency and Qi Yin deficiency syndrome are rare.2.The left ventricular systolic dysfunction was accompanied by diastolic dysfunction in patients with chronic heart failure stage B.LVEF was negatively correlated with E/E' and the correlation coefficient between them was statistically significant,suggesting that the lower the left ventricular systolic function,the larger the E/E_value,the lower the left ventricular diastolic function.There was no significant difference in LVEF and BNP among different TCM syndromes in patients with chronic heart failure stage B.LVEF was negatively and positively correlated with BNP and E/A respectively,but the correlation coefficients between them were not statistically significant.E/E' ratio is more sensitive than E/A ratio in reflecting left ventricular diastolic function in patients with chronic heart failure stage B.