Chronic Heart Failure, Ventricular Arrhythmia Syndromes Characteristics And Prognostic Value

BackgroundChronic heart failure (CHF) is the end stage of various heart diseases and has the characteristics of high incidence rate and poor prognosis.Ventricular arrhythmia, as one of the most common complications, has close relationship with the prognosis. At present, with the spreading of the related research on traditional Chinese medicine (TCM), the study based on syndrome elements about the value of the prognosis of CHF has achieved some results, but because of the complexity of the disease, a great deal of clinical features, the different methods of TCM syndrome differentiation and the various patterns of syndrome, there is few research about the relationship between the ventricular arrhythmia in patients with CHF and the syndrome elements of TCM and their prognostic value.Therefore, we try to find out the classification standard of the ventricular arhythmia which has the prognostic value of CHF and its relationship with the syndrome elements and the clinical features, expecting to do a preliminary study of prognostic value of the ventricular arrhythmia in patients with CHF.ObjectiveTo investigate the prognosis value of the ventricular arrhythmia in TCM syndrome characteristics of CHF and its influencing factors.MethodsFirst of all, we collected180cases of CHF patients who met the inclusion criteria and were hospitalized in Guang Anmen Hospital from June2006to August2013.Secondly we set up a retrospective collection form of the medical record data, including the basic information, the relevant medical history, the auxiliary examination results, the clinical diagnosis and the final events of all patients which were followed-up by outpatient or telephone. Thirdly we explored the group standard about the premature ventricualr contractions which has the prognostic value of CHF by ROC curve and analysis it by Survival-Analysis Method. At last, we explored the relationship of the grouping levels of the ventricular premature with TCM syndrome elements and the clinical features of CHF.Results1. The survival rate in patients with CHF was60.9%and the all-cause mortality rate was39.1%. The single syndrome elements distributions from more to less were Qi deficiency (75.6%), blood stasis (66.7%), phlegm block (53.9%), Yin deficiency (37.8%) and Yang deficiency (16.7%).2. The2030as the cut-off point was calculated as the number of PVC in patients with CHF per24hours by ROC curve. Kaplan-Meier-Survival-Analysis showed that the PVC>2030beats/24h patients than the PVC<2030beats/24h ones have the worse long-term prognosis and the differences were statistically significant.3. There was no significant association between the grouping levels of PVC in patients with CHF which have the prognostic value and the single syndrome elements. And the grouping levels were negatively related with syndrome which combines Yang deficiency with phlegm block, but were no related with any other two kinds of syndrome elements combination.4. The correlation analysis showed that LVEDD、RVEDD、RAEDD、the severity of aortic regurgitation、Hb、Cr、NT-proBNP、Sex were negatively related with the grouping levels of PVC. And LVEF、FS、Hyperlipidemia were positively related with the grouping levels of PVC.Conclusions1. PVCs can be used as an independent factor affecting the prognosis of patients with CHF.Taking about2000beats per24hour as the grouping criteria of PVCs, the high risk group than the low risk group in patients with CHF has the significant worse long-term prognosis.2. Qi deficiency, blood stasis, phlegm block, Yin deficiency, Yang deficiency were the most basic TCM syndrome elements of TCM. The grouping levels of PVC in patients with CHF which have the prognostic value were associated with syndrome elements, but the specific contact of them need to be studied in the further time.3. With the increased of LVEED、RVEDD、RAEDD、the severity of aortic regurgitation、Hb、Cr、NT-proBNP and the decreased of LVEF、EF, it will tend to be the high risk group of PVCs in patients with CHF. Female patients than male patients, patients without hyperlipidemia than patients with hyperlipidemia will be more likely to be the high risk group of PVCs in patients with CHF.