The Distribution And Clinical Characteristics Of TCM Syndromes Of HFpEF Combined With Atrial Fibrillation And Its Comparison With HFrEF Combined With Atrial Fibrillation

Objective:By focusing on the analysis of the TCM syndromes distribution rules and clinical characteristics in patients with heart failure with preserved ejection fraction(HFpEF)and atrial fibrillation,and comparative study on patients with heart failure with reduce-d ejection fraction(HFrEF)combined with atrial fibrillation.At the same time analyze the risk factors of atrial fibrillation.The purpose of this study is to explore the underlying pathophysiological mechanism of HFPEF and HFrEF combined with AF and provide objective data and theoretical basis for TCM syndrome differentiation,in order tobetter guide clinical practice.Methods:This paper adopts the method of retrospective analysis,and select patients with heart failure with preserved ejection fraction and reduced ejection fraction who were hospitalized in the Department of Cardiology of Integrated traditional Chinese and Western Medicine from January 2014 to January 2020 in China-Japan Friendship Hospital.Collecting general information,comorbidities,TCM syndromes,clinical biochemical indexes,and echocardiographic results of inpatients using the Jiahe medical record system,and input the data into Excel 2010 to integrate the data set database,and divide it into four groups according to whether it is complicated with atrial fibrillation or not:1)heart failure with preserved ejection fraction and atrial fibrillation group,2)heart failure with preserved ejection fraction and non-atrial fibrillation group,3)heart failure with reduced ejection fraction and atrial fibrillation group,4)heart failure with reduced ejection fraction and non-atrial fibrillation group.Using spss21.0 statistical software to analyze the distribution and clinical characteristics of TCM Syndrome types of different heart failure groups,and comparing the two groups according to whether the variables are consistent with each other in normal distribution,nonparametric test or analysis of variance were used respectively,and multiple comparisons were made within the group.According to the correlation,the risk factors of AF were analyzed by logistic regression.The results were statistically significant(P<0.05).Results:1.General data:a total of 343 patients were enrolled,with an average age of 73±12 years old,176 males and 167 females.Among the 236 patients with HFpEF,there were 150 patients with atrial fibrillation and 86 patients with non-atrial fibrillation,70 patients with atrial fibrillation and 37 patients with non-atrial fibrillation in 107patients with HFrEF.In both HFpEF group and HFrEF group,the average age of AF group(78.2±8;67.8±12.5)was significantly higher than that of non-AF group(71.7±11;61.2±14.1),(P<0.001/0.016).There were 43(50%)male and 43(36%)female in HFPEF non-AF group,and 96(64%)women in HFPEF-AF group.The difference was statistically significant(P=0.035).HFrEF sex composition ratio was not statistically significant.No matter HFPEF group or HFrEF group,the heart rate of patients with AF was significantly higher than that of patients without AF(P<0.05),but there was no significant difference in BMI,smoking,drinking,systolic blood pressure and diastolic blood pressure.2.Distribution of syndrome types:the distribution of syndrome types in HFpEF atrial fibrillation group was qi deficiency and blood stasis>yang deficiency and water flooding>phlegm and blood stasis block>qi and yin deficiency>phlegm stasis blocking lung,non-atrial fibrillation group was qi deficiency and blood stasis>qi and yin deficiency>yang deficiency and water flooding>phlegm and blood stasis blocking lung>phlegm and blood stasis block.The distribution of syndrome types in HFrEF atrial fibrillation group was Yang deficiency and water flooding>phlegm stasis block>Qi deficiency and blood stasis>Qi Yin deficiency>phlegm stasis blocking lung,while in non atrial fibrillation group,Qi deficiency and blood stasis>phlegm stasis block>Yang deficiency and water flooding>Qi Yin deficiency>phlegm stasis blocking lung,the difference was not statistically significant(P>0.05).3.The main symptoms of heart failure and atrial fibrillation complicated with coronary heart disease were qi deficiency and blood stasis(p<0.05).4.Syndrome type distribution and clinical indexes of HFPEF and HFrEF patients with atrial fibrillation:In HFpEF patients with atrial fibrillation,there was significant difference in the level of NT-proBNP between the phlegm stasis blocking lung and yang deficiency and water flooding(P<0.01).In HFrEF patients with atrial fibrillation,the level of NT-proBNP in patients with yang deficiency and water flooding syndrome was significantly higher than that in patients with qi deficiency and blood stasis syndrome,qi and yin deficiency syndrome and phlegm and blood stasis syndrome(P<0.01).And the NT-proBNP level of Yang deficiency and water flooding syndrome in both groups was relatively high.There was no significant difference in NYHA,blood lipid and echocardiographic indexes of different syndromes,but the proportion of heart function ? of NYHA with Yang deficiency and water flooding was the largest.5.The most common complications of HFpEF patients with atrial fibrillation and non-atrial fibrillation were hypertension(80.7%,83.7%),coronary heart disease(40.7%,59.3%,P<0.05),hyperlipidemia(36.7%,55.8%,P<0.05),stroke(36%,43%),and type 2 diabetes(32%,62.8%,P<0.05.HFrEF patients with atrial fibrillation and non-atrial fibrillation were more likely to have hypertension(62.9%;86.1%,P<0.05).In),diabetes(47.1%;58.3%),coronary heart disease(45.7%,86.1%,P<0.05).6.The levels of HsCRP in HFpEF patients with atrial fibrillation were higher than those in patients without atrial fibrillation,while the levels of total cholesterol and high density lipoprotein in patients with);HFrEF were lower than those in patients without atrial fibrillation(P<0.05).Creatinine and uric acid in patients with atrial fibrillation were higher than those in patients with non-atrial fibrillation(P<0.05).7.Comparison of cardiac function:In patients with HFpEF complicated with atrial fibrillation comparison of cardiac function:NYHA-?(56%)>NYHA-?(25.3%)>NYHA-?(18.7%),and in non-atrial fibrillation group NYHA-?(41.9%)>NYHA-?(33.7%)>NYHA-?(24.4%).NYHA cardiac function grade in atrial fibrillation group was higher than that in non-atrial fibrillation group,and the difference between the two groups was statistically significant.The logarithm of NT-proBNP accorded with normal distribution,Lg-NTproBNP in HFpEF atrial fibrillation group was higher than that in non-atrial fibrillation group,and there was significant difference between the two groups(P<0.05).There was a positive correlation between NYHA grade and NT-proBNP.Lg-NTproBNP in HFrEF atrial fibrillation group was significantly higher than that in non-atrial fibrillation group(P<0.05).Although the proportion of NYHA-? and NYHA-? in atrial fibrillation group was higher than that in non-atrial fibrillation group,there was no significant difference between the two groups.There was no significant difference in LVEF between HFpEF and HFrEF,groups.8.Comparison of cardiac structure:LAD in HFpEF and HFrEF patients with atrial fibrillation was higher than that in patients without atrial fibrillation(P<0.01),but there was no significant difference in other ultrasonic indexes.9.Logstic regression analysis showed that LAD[OR=1.041,95%CI(1.004-1.080,0.030)],age[OR=1.039,95%CI(1.004-1.075,0.029)],type 2 diabetes[OR=3.327,95%CI(1.706-6.487),P<0.001],hyperlipidemia[OR=2.114,95%CI(1.085-4.12,0.028)]were the risk factors of atrial fibrillation in HFpEF,and there was a positive correlation.However,it was negatively correlated with male[OR=1.039,95%CI(1.004-1.075,0.029)].HFrEF left atrial diameter LAD[OR=1.455,95%CI(1.208 to 1.753),P<0.001],age[OR=1.085,95%CI(1.028?1.146),P=0.003]were the risk factors for atrial fibrillation in HFrEF,and there is a positive correlation.Conclusion:1.There is a strong correlation between HFpEF atrial fibrillation and women,and there is a positive correlation between age and atrial fibrillation,and it is a risk factor for atrial fibrillation.The older the age is,the more likely it is to have atrial fibrillation.2.Patients with HFpEF atrial fibrillation and HFrEF atrial fibrillation are mainly deficiency syndrome,the distribution of HFpEF atrial fibrillation syndrome is mainly qi deficiency and blood stasis,yang deficiency and water flooding,phlegm and blood stasis block,HFrEF atrial fibrillation syndrome is mainly yang deficiency and water flooding,phlegm and blood stasis,qi deficiency and blood stasis,so heart failure atrial fibrillation is mainly characterized by deficiency and excess,with heart qi deficiency and yang deficiency as the basis,as well as yin deficiency,and blood stasis,water stagnation and phlegm as the standard.3.In patients with HFpEF atrial fibrillation and HFrEF atrial fibrillation,the cardiac function of yang deficiency water flooding syndrome is relatively poor,and their NT-proBNP level and NYHA cardiac function classification are higher,so we can consider the use of clinical indicators to provide theoretical basis for TCM syndrome differentiation.4.HFpEF atrial fibrillation complicated with hypertension and coronary heart disease,and diabetes and hyperlipidemia are the risk factors of atrial fibrillation,non-atrial fibrillation patients are mostly hypertension,diabetes and coronary heart disease;HFrEF group atrial fibrillation and non-atrial fibrillation patients with hypertension,diabetes and coronary heart disease are more common.5.HFpEF patients with atrial fibrillation had higher levels of inflammatory marker HsCRP and lower levels of total cholesterol and high-density lipoprotein.Patients with HFrEF af have higher levels of uric acid and creatinine.6.The cardiac function of HFpEF patients with atrial fibrillation was worse than that of non-atrial fibrillation patients,and there was a positive correlation between NT-proBNP and NYHA cardiac function classification.The higher the level,the worse the cardiac function.The level of NT-proBNP in patients with HFrEF atrial fibrillation is higher than that in patients without atrial fibrillation,and NYHA of cardiac function classification is relatively higher.7.Left atrial diameter is a risk factor for HFpEF and HFrEF in atrial fibrillation,suggesting that changes in cardiac structure,especially atrial remodeling,can be the pathophysiological mechanism for the interaction of atrial fibrillation heart failure.