The Relationship Between The Blood Pressure Difference Between The Limbs And The Heart Function And TCM Syndromes In Patients With Chronic Heart Failure

Background:The blood pressure difference between the limbs mainly includes the inter-arm systolic blood pressure difference(IASBP),that is,the difference in bilateral brachial artery systolic blood pressure,and the inter-leg systolic blood pressure difference(ILSBP),namely The absolute value of the difference of bilateral ankle systolic pressure.The abnormal increase in the difference often indicates that the body is in a pathological state.In recent years,many documents have reported that the abnormal increase in blood pressure between the ankle and arm can increase the risk of cardiac structural changes(such as left ventricular hypertrophy,relative ventricular wall thickening),In addition,based on transthoracic echocardiography,some foreign scholars have found that the systolic and diastolic functions of the normal people are significantly better than those with abnormally increased blood pressure differences between limbs.What is more,The composition ratio of patients with central failure of the group with a blood pressure difference≥10mmHg between the arms is also much larger than that of the normal population.It is worth mentioning that the difference in blood pressure between arms and ankle can be used as a reliable indicator to predict the risk of poor prognosis for subjects.purpose:This study aims to investigate the detection of abnormal ankle and arm blood pressure differences in patients with heart failure with different heart functions,and to explore whether the blood pressure differences between limbs are related to the severity of heart failure patients and cardiovascular prognosis.Discover different TCM syndrome types the distribution of the blood pressure difference between the ankle and arm of the patients with heart failure,to clarify whether the abnormal blood pressure difference between the limbs is suggestive for the heart failure patients with Yang deficiencyand blood stasis syndrome.methods:Enrolled 249 heart failure patients who were hospitalized in the Cardiovascular Center of the Affiliated Hospital of Gansu University of Traditional Chinese Medicine from September2018 to December 2020,and were followed up for 6-9 months to record the occurrence of cardiovascular events during the follow-up period;Two automatic electronic blood pressure monitors(Omron HEM-7211)were used to simultaneously measure the blood pressure difference between the ankle and arm of all subjects.General demographic data,laboratory test indicators,Cardiac color Doppler ultrasound indicators,the Minnesota Heart Failure Quality of Life Scale(MLHFQ score),YHA heart function grading,collecting four-diagnosis information,and performing TCM syndrome types through questionnaires.The normal range of blood pressure difference between arms and ankle is defined as≤10mmHg.According to NYHA heart function classification,249 patients with heart failure were divided into severe heart failure group(NYHAⅢ-NYHAⅣ)with 161 patients and nonsevere heart failure group(NYHAII)with 88 patients.Explore the abnormal detection rate of blood pressure difference between limbs of patients with heart failure with different heart functions,and clarify the significance of blood pressure difference between limbs for heart function and patient prognosis;explore the distribution of blood pressure difference between limbs of different TCM syndromes,and clarify the ankle and arm Whether the difference in blood pressure is of auxiliary value in the traditional four-diagnosis system for TCM differentiation of heart failure.result:(1)Among the 249 patients with heart failure included,161 were severe chronic heart failure patients(NYHAⅢ-Ⅳ),88 were non-severe heart failure patients(NYHAII),and patients with severe cardiac insufficiency group with abnormal ankle blood pressure difference(≥10mmHg)The composition ratio of HBV was 30.4%,which was much higher than that of the normal control group(10.3%)and the non-severe heart failure group(8.0%).(2)Using ROC curve analysis,it is found that ILSBP and IASBP have certain diagnostic efficacy for severe heart failure,and the AUCs of the two for diagnosing severe heart failure are 0.704 and 0.632,respectively.Through Cox regression analysis,it is concluded that ILSBP≥10mmHg can still increase the risk of cardiovascular events in patients with heart failure(HR2.321 95%CI: 1.143-4.712,P<0.05);IASBP cannot be found for the cardiovascular prognosis of patients with heart failure There is an impact.(3)The constituent ratios of ILSBP and IASBP≥10mmHg in subjects with Yang Qi deficiency and blood stasis syndrome were significantly greater than those in patients with Qi deficiency and blood stasis syndrome(P<0.05);logistic regression showed that ILSBP≥10mmHg can increase the number of patients with heart failure.The risk of Yang deficiency and blood stasis syndrome.(4)Regarding the TCM syndromes of patients with chronic heart failure as state variables,they are divided into the Yang Qi deficiency and blood stasis syndrome group and other syndrome groups.After drawing the ROC curve,it is found that the inter-ankle blood pressure difference(ILSBP)diagnoses the Yang Qi deficiency and The area under the curve of blood stasis syndrome is AUC is 0.602,(P<0.05);the best segmentation site corresponding to Youden index is 9.5mmHg(sensitivity0.38;specificity 0.84).conclusion:(1)The detection rate of abnormally increased ankle blood pressure difference(≥10mmHg)in patients with severe heart failure is higher than that of patients with mild heart failure and non-heart failure control group.(2)Both the inter-ankle blood pressure difference(ILSBP)and the inter-arm blood pressure difference(IASBP)have certain testing power for severe cardiac insufficiency.ILSBP≥10mmHg can increase the risk of cardiovascular events in patients with heart failure(HR2.321;P<0.05).(3)Compared with subjects in the Qi deficiency and blood stasis syndrome group,thedetection rate of heart failure patients with Yang Qi deficiency and blood stasis syndrome of blood pressure difference≥10mmHg between ankle and arm was significantly higher;With the increase of ILSBP,the risk of developing Yang-deficiency and blood stasis syndrome in patients with heart failure also increases.