| Objective1 To explore the distribution characteristics of TCM syndrome elements and syndrome patterns in patients of hypertension(HTN)with left ventricular hypertrophy(LVH),and to compare the differences in the distribution of TCM syndrome patterns with hypertension patients without LVH.2 Two-dimensional speckle tracking imaging(2D-STI)was used to quantitatively detect the left atrial volume and atrioventricular myocardial strain in patients with LVH,and to evaluate atrioventricular function.MethodsA total of 137 patients with HTN were divided into HTN with LVH group(LVH group)and HTN without LVH group(Non-LVH group),the basis of clinical data and TCM diagnostic information,physical examination,conventional echocardiography,2D-STI evaluation were performed,to compared the difference of general data,TCM syndrome elements,TCM syndrome patterns and atrioventricular function between LVH group and Non-LVH group.As a control group,20 healthy subjects were included.Results:1 Clinical basic featuresIn the end,137 patients with HTN were included,including 85 patients without LVH(Non-LVH group)and 52 patients with LVH(LVH group).The age,systolic blood pressure(SBP),diastolic blood pressure(DBP),waist circumference(WC),and body mass index(BMI)level of HTN group were higher than those of control group,and the proportion of abdominal obesity,overweight,obesity and menopause of women were higher than those of control group(all P<0.01).52HTN patients(38.0%)were associated with LVH,including 17 males and 35 females.The proportion of female HTN patients with LVH was higher than that of male patients.The average age of both Non-LVH group and LVH group was more than 60 years old.Postmenopausal women,overweight and abdominal obesity were more common and calcium channel blocker(CCB)was widely used in both groups.Compared with non-LVH group,LVH group had higher BMI level,longer duration of HTN,higher proportion of abdominal obesity,combined urinary protein,overweight and obesity,and using CCB medication(all P<0.05).2 The distribution characteristics of TCM syndrome elements and syndrome patterns(1)The top ten symptoms of HTN were dizziness,insomnia,shortness of breath,headache,fatigue,palpitation,spontaneous sweating,chest tightness,tinnitus,and head distension.The top ten tongue pulse manifestation are string pulse,white moss,dim tongue,sublingual vein tortuous,thin moss,greasy moss,heavy pulse,yellow moss,smooth pulse,and toothed tongue.(2)The weight coefficients of TCM syndrome elements in HTN patients with descending order were:yang hyperactivity>qi deficiency>yin deficiency>phlegm turbidity>yang deficiency>blood stasis.There were yang hyperactivity>qi deficiency>yin deficiency>phlegm turbidity>blood stasis>yang deficiency in Non-LVH group and qi deficiency>yang hyperactivity>yin deficiency>phlegm turbidity>yang deficiency>blood stasis in LVH group.Qi deficiency,phlegm turbidity,yang deficiency and blood stasis syndrome elements in LVH group were more prominent than those in Non-LVH group.Yang hyperactivity and yin deficiency were more obvious in Non-LVH group compared with LVH group.(3)Yin deficiency with hyperactive of liver yang syndrome pattern was most common in both Non-LVH group and LVH group.The syndrome pattern of hyperactivity of liver fire was the least in LVH group,while phlegm turbidity and qi deficiency syndrome pattern was the least in the Non-LVH group.There were no statistical significance in the overall TCM syndrome patterns between 2 groups(P>0.05).(4)Among all syndrome elements and patterns,patients aged between 56 and 70 accounted for the largest proportion,and the proportion of females was higher than that of males.There was statistical difference between yin deficiency with hyperactive of liver yang syndrome pattern and phlegm turbidity and qi deficiency syndrome pattern in different age stratification(P=0.037).3 Echocardiographic indicators(1)Routine echocardiographic indicatorsCompared with the control group,the diameter of atrial and ventricular,left atrial volume index(LAVI),ventricular wall thickness,and left ventricular mass index(LVMI)were increased in the HTN patients(all P<0.05).Compared with Non-LVH group,LVH group had larger atrial and ventricular diameter,thicker ventricular wall,higher LVMI,and greater LAVI(all P<0.01).The left ventricular diastolic function was impaired in the HTN patients,and the diastolic function decreased more obviously in LVH group than in Non-LVH group(all P<0.05).In HTN patients,arterial and left ventricular stiffness increased and arterial compliance decreased(all P<0.05).Cardiac power(corrected by LVMI)in LVH group was lower than that in Non-LVH group(P<0.001).(2)Compared with control group,left atrial volume of different phase(included LAmax,LApre and LAmin),active emptying volume(LAVa),left atrial filling fraction(AFF)increased,left atrial total emptying fraction(LAVtEF),passive emptying fraction(LAVpEF)and left atrial conduit volume(LAVC),the ratio of LAVC to stroke volume were reduced in HTN patients(all P<0.05),left atrial volume of different phase in LVH group were greater than Non-LVH group(all P<0.05);Compared with control group,global longitudinal strain(|GLS|),strain during reservoir(LASr),peak strain rate during reservoir(pLASRr),strain during conduit(LAScd),peak strain rate during conduit(pLASRcd),peak strain rate during contraction(pLASRct)were reduced,16-standard deviation of strain time(16-TsSD)and left atrial stiffness index(LASI)increased(all P<0.001);In LVH group,left ventricular systolic function,left atrial reserve function and left atrial conduit function were more severely impaired,and left atrial stiffness was higher(all P<0.05).4 LVH subgroup analysis-BNP normal group and BNP elevated group The duration of HTN in BNP elevated group was longer than that in BNP normal group.The left atrial diameter,left atrial volume of different phase and LASI were increased(all P<0.05),and pLASRr,pLASRcd,strain during contraction(LASct),pLASRct were decreased(all P<0.05).5 Relationship between atrioventricular structure and reduction of atrioventricular strain The incidence of reduced |GLS| in the population of highest quartile of LVMI was highest(79.5%)(P<0.001).The incidence of reduced LASr was highest(71.8%)in the population of the highest and third quartiles of LAVI(P=0.032).With the first quartile of LVMI for reference,the risk of reduced |GLS| in the population of highest and third quartiles of LVMI significantly increased(adjusted OR3=3.62,95%CI:1.21～10.86,P=0.022;adjusted OR4=4.49,95%CI:1.42～14.22,P=0.011).The risk intensity was higher in males than in females.Multivariate logistic regression analysis with continuous variable of LVMI showed that after adjusted for age,sex,heart rate,SBP,DBP,LAVI,BNP,E/e’,LVMI is still the risk factor for |GLS|reduction(OR=1.03,95%CI:1.01～1.05,P=0.012).6 Multivariate regression analysis of atrioventricular function damaged and TCM syndrome elementsBinary multivariate logistic regression analysis showed that qi deficiency is closely related with the increased risk of |GLS| and LASr co-impaired(P=0.037).7 Correlation analysis of LASI with left atrial volume,emptied fraction and strain LASI was positively correlated with left atrial volume of different phases,and negatively correlated with left atrial emptied fraction of different phases,pLASRr,LAScd,pLASRcd,LASct,pLASRct(all P<0.001).8 ROC curve analysis of diagnostic HTN with BNP elevation LASI was more effective than LAVI and E/e’ in predicting left ventricular filling pressure elevated.The prediction cut-off point of LASI was 0.35,the area under the curve was 0.73,and the sensitivity and specificity were 62.9%and 71.6%,respectively.Conclusion:1.The TCM syndrome pattern of HTN patients were characterized by asthenia in origin and excess in superficiality,and yin deficiency with hyperactive of liver yang syndrome pattern was most common in HTN patients regardless of whether accompanied by LVH.The syndrome elements of phlegm turbidity,qi deficiency,Yang deficiency and blood stasis were more prominent in LVH patients compared with non-LVH patients.2.Atrioventricular remodeling and functional impairment have been observed in patients with HTN,the reduction of atrioventricular function occurred before the remodeling at the ultrasonic level,especially in patients with LVH.3.Atrioventricular remodeling increases the incidence of decreased atrioventricular function.With the increase of LVMI,the risk of decreased left ventricular systolic function in males is higher than that in females.Qi deficiency increased the risk of co-impaired atrioventricular function.4.PreHFpEF patients with damaged cardiac structure and elevated BNP require early intervention and management. |
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