| Objective1.To review the clinical characteristics and medications of patients with heart failure in the Department of Cardiology,the First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,to provide references for further standardizing clinical diagnosis and treatment.2.To grasp the TCM syndrome characteristics and differences of heart failure with reduced ejection fraction(HFr EF),heart failure with preserved ejection fraction(HFp EF)and heart failure with mid-range ejection fraction(HFmr EF),so as to provide guidance for clinical syndrome differentiation and treatment.Methods1.Using the method of retrospective investigation and analysis,302 patients with heart failure were included in the cardiovascular department of the First Teaching Hospital of Tianjin University of traditional Chinese medicine from January 2017 to January 2019.According to the left ventricular ejection fraction(LVEF),they were divided into 123 cases in HFr EF group,134 cases in HFp EF group and 45 cases in HFmr EF group.The patients’ names,gender,age,cardiac function classification,etiology and complications,clinical medication,laboratory indicators,echocardiography indicators and four diagnostic information of traditional Chinese medicine were recorded respectively,and the database was established and clinical data were entered.2.Spss25.0 was used to analyze the data,chi square test was used to count the data between groups,and single factor analysis of variance or rank sum test was used to measure the data.Results1.General data comparisonThe average age and proportion of women,hypertension and atrial fibrillation in HFp EF group were higher with significant differences statistically than that in HFr EF and HFmr EF group(P<0.05);The proportion of smoking,drinking and fattening in HFr EF group were higher than that in HFp EF group with significant differences statistically(P<0.05);NYHA Ⅱ level ofHFr EF group was less than HFp EF and HFmr EF group,The NYHA Ⅳ level of HFr EF group was more than HFp EF groups with significant differences statistically(P <0.05).2.Characteristics of laboratory and echocardiographic indexes(1)Laboratory indexThe levels of hemoglobin(HGB),creatinine(CR),uric acid(UA)and chlorine(Cl)in HFr EF group were significantly higher than those in HFp EF group(P<0.05),while BNP in HFr EF group was significantly higher than those in HFp EF group and HFmr EF group(P< 0.05).(2)Echocardiographic indexThe left ventricular end diastolic diameter(LVEDD)and right ventricular anteriorposterior diameter(RVD)of the HFr EF group were higher than that of the HFp EF group and the HFmr EF group,with significant differences statistically(P<0.05).The ventricular septum thickness(IVS)of HFp EF group was higher than that of HFr EF group,and the difference was statistically significant(P<0.05).3.Application of standardized medication in HFr EF groupThe application rates of angiotensin converting enzyme inhibitors(ACEI)/angiotensin Ⅱreceptor antagonist(ARB)/angiotensin receptor neprilysin inhibitor(ARNI),beta blockers,and aldosterone receptor antagonist(MRA)in HFr EF group in accordance with the indications and excluded contraindications were 67.6%,79.1% and 94.1%.4.Distribution of TCM syndrome elements(1)Distribution of TCM syndromes of different types of heart failureIn the HFr EF group,the deficiency syndrome was Qi deficiency(99.2%)>Yin deficiency(26.8%)>Yang deficiency(22.8%),and the solid syndrome was blood stasis(68.3%)>water drink(62.6%)> phlegm(58.5%)> heat stagnation(26.8%)> qi stagnation(1.6%);in the HFp EF group,the deficiency syndrome was Qi deficiency(97.0%)>Yin deficiency(53.7%)>Yang deficiency(8.2%),the solid syndrome elements were blood stasis(92.5%)>phlegm(75.4%)> water drink(67.2%)> heat accumulation(50.0%)> Qi stagnation(3.7%);the deficiency syndrome in the HFmr EF group was Qi deficiency(100.0%)>Yin deficiency(31.1%)> Yang deficiency(15.6%),and the solid syndrome elements were blood stasis and water drink(64.4%)>phlegm(60.0%)>heat accumulation(28.9%)> Qi stagnation(2.2%).(2)Comparison of TCM syndrome elements of different types of heart failureElements of deficiency syndrome: Qi deficiency was HFmr EF(100.0%)>HFr EF(99.2%)> HFp EF(97.0%),Yin deficiency was HFp EF(53.7%)>HFmr EF(31.1%)>HFr EF(26.8%),Yang deficiency was HFr EF(22.8%)>HFmr EF(15.6%)>HFp EF(8.2%);Solid syndrome elements: Blood stasis was HFp EF(92.5%)>HFr EF(68.3%)>HFmr EF(64.4%),phlegm was HFp EF(75.4%)>HFmr EF(60.0%)>HFr EF(58.5%),water drink was HFp EF(67.2%)>HFmr EF(64.4%)>HFr EF(62.6%),heat accumulation was HFp EF(50.0%)>HFmr EF(28.9%)>HFr EF(26.8%),Qi stagnation was HFp EF(3.7%)>HFmr EF(2.2%)>HFr EF(1.6%).Conclusion1.HFp EF patients in our hospital are mostly elderly women,often with hypertension and atrial fibrillation;HFmr EF patients are more similar to HFr EF in terms of gender,etiology and comorbidities;The application of HFr EF patients in ACEI/ARB/ ARNI,β-blockers and MRA were higher than the domestic average level,but there was a certain gap between the guidelines and the recommendations.2.The traditional Chinese medicine syndrome of heart failure was characterized by the deficiency of the standard,and the deficiency of HFr EF was mainly based on the deficiency of Qi,as well as the deficiency of Yin and Yang;The standard was mainly blood stasis,phlegm and water.Compared with HFr EF,HFp EF Deficiency was more prominent with Yin deficiency,and standardization was more prominent with blood stasis,phlegm turbidity,and heat accumulation;HFmr EF TCM syndrome characteristics were mostly between the two,closer to HFr EF. |
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