Different Syndromes Long-term Prognosis In Patients With Chronic Heart Failure And Its Influencing Factors Is Analyzed

BackgroundChronic heart failure (CHF) is the serious stage of various kinds of cardiovascular diseases and often shows the high morbidity and poor prognosis.Along with the development of this disease,different syndrome elements have different effects on its prognosis,so it has particular developing laws of syndromes of TCM and.Although the heart failure research based on syndrome elements have yielded some results,as the complexity of the disease itself and the effects of the medication on syndrome development and various methods of symptoms differentiation,there are still no common understanding on the developing laws of syndromes of TCM and the prognosis of CHF.Therefore,we analyzed the different prognosis of CHF patients with different syndrome elements,and searched the factors which have the influence on the syndrome differentiation and death.Tried to explore the long-term prognosis of patients with chronic heart failure from the point of view of TCM syndrome elements.ObjectivesTo explore the long-term prognosis of chronic heart failure patients with different TCM syndromes and to invest the influencing factors.MethodsWe collected191cases of CHF patients who were hospitalized in Guang Anmen Hospital from June2006to August2011.Then we gathered their general information, incidence and relevant medical history,and then extracted the syndrome elements of them.All patients were outpatient or telephone followed-up,to obtain their final events.And then we used Survival-Analysis Method to explore the prognosis of CHF patients with different TCM syndromes.Searched the impacts of general information,ECG and biomarkers on the syndrome differentiation and death.Results1.The all-cause mortality rate was28.69%,and Qi deficiency was the most frequently witness syndrome element.And two syndrome elements combination was the most common elements combination.2.Kaplan-Meier-Survival-Analysis showed that non-Qi-deficiency patients than Qi-deficiency ones,Yang-deficiency patients than non-Yang-deficiency ones,non-phlegm block patients than phlegm block ones have worse long-term prognosis and the differences were statistically significant.Besides,Yin-deficiency patients than non-Yin-deficiency ones,blood stasis patients than non-blood stasis ones have no significant statistical difference of long-term prognosis. And we compared the long-term prognosis between the five syndrome elements,the analysis result shows that from best to worst were phlegm block ones,Qi-deficiency ones,Yin-deficiency ones,blood stasis ones,Yang-deficiency ones and the differences were statistically significant.3.The binary Logistic Regression Analysis showed thatQi-deficiency0.616-0.044×disease duration-6.774×LVEF. Yang-deficiency=1.199+0.048×disease duration, and the other equations were built failed,no variables entered into the equation.4.The correlation analysis showed that Qi-deficiency and TC was negatively related.And Yang-deficiency was positively related with duration of disease, RBC and Hb,and negatively related with LVEF.And Yin-deficiency and NT-proBNP was positively related.And blood stasis was positively related with duration of disease and negatively related with NYHAe.And phlegm block was positively related with Cr, NT-proBNP and negatively related with WBC,5.Kaplan-Meier-Survival-Analysis showed that NYHAcⅡclassfied ones than NYHAcⅢclassfied ones,NYHAcⅢ classfied ones than NYHAcⅣ classfied ones,LVEF>40%ones than LVEF<40%ones,FPVB<1950.5beats/24h ones than FPVB>1950.5beats/24h ones, NT-proBNP<3279pg/ml ones than NT-proBNP>3279pg/ml ones, LVM<232.67g ones than LVM>232.67g ones have better long-term prognosis and all the differences were statistically significant.Besides,to compared the characters such as gender,age,duration of disease, wether fibrillation of the patients,the results showed there were no statistically differences.5. We used Cox-regression Survival Analysis to build the equation of the risk of death,the equation is h(t,x)/ho(t)=EXP(0.005x PIt+0.015×Cr-0.002×AST+0.035×IBIL).Conclusions1.Chronic heart failure patients have poor prognosis,Qi deficiency and Blood Stasis was its common syndrome, and more syndrome elements combination was often observed.2. Along with the development of the disease,Qi-deficiency and Phlegm block was at the beginning of the disease,and Yang-deficiency was at the later period of CHF, Yin-deficiency and Blood stasis throughout the entire process,and Blood stasis gradually exacerbated the condition3.NYHAc,LVEF,NT-proBNP, duration of the disease might be used as the syndrome elements indicators,but the relevance of them remains need further studies.4.NYHAc、LVEF、NT-proBNP、FPVB and LVM have certain influence on the incidence of death of the CHF patients.As the increase of NYHAc, NT-proBNP, FPVB, LVM and the decrease of LVEF, the long-term prognosis of the CHF patients became worse.Besides, the trends of the influence of gender,age and duration of the disease on the prognosis were also clear.