Correlation Analysis Between TCM Syndrome Elements And Cardiopulmonary Exercise Test Indexes In Heart Failure Patients With Preserved Ejection Fraction

ObjectiveTo explore the TCM syndromes and syndrome elements distribution characteristics of heart failure patients with preserved ejection fraction(HFp EF),and to analyze the correlation between TCM syndrome elements and cardiopulmonary exercise test(CPET)indexes in patients with HEp EF,so as to provide reference for the objective,concrete and modern TCM syndrome differentiation and treatment of HFp EF.Methods60 HFp EF patients were randomly divided into the control group and the treatment group.The patients in the control group were treated with routine western medicine,and the patients in the treatment group were treated with Yangyin Shuxin Decoction on the basis of routine western medicine.The two groups were intervened for 14±3 days.The basic information,TCM four diagnostic information subscales and cardiopulmonary exercise test indicators were collected and collated before and after treatment.According to the TCM four diagnostic information scale and 《Syndrome Differentiation·Syndrome Differentiation Scale》,the simplified measurement weight(hereinafter referred to as syndrome weight)and the sum of syndrome weight of syndrome elements corresponding to syndromes(hereinafter referred to as syndrome elements weight)were calculated,and the TCM syndrome elements of HFp EF patients were obtained.The characteristics of TCM syndromes and syndrome elements before treatment were analyzed based on the weight coefficient method and the syndrome element weight method,and the correlation between the weight of each syndrome element before and after treatment and the cardiopulmonary exercise test indexs was analyzed.Results1.Analysis of baseline informationThe HFp EF patients in this study were mainly elderly,female,overweight and obesity.Hypertension were major.NYHA(New York Heart Association)cardiac function classification grade I and II accounted for 75%.There was no significant difference between the treatment group and the control group in baseline data before treatment(P>0.05),indicating comparability.2.Analysis of syndrome characteristicsThe top 10 of high weight coefficients of of symptoms and signs in patients with HFp EF in this study were hypodynamia,shortness of breath,insomnia,breathlessness,dizziness,palpitation,chest discomfort,mouth dryness,upset-irritability,and lower extremity.The top 10 of high weight coefficients of of tongue images were yellow tongue coating,thick tongue coating,dim tongue,sublingual venae,greasy tongue coating,thin tongue coating,white tongue coating,light-red tongue,dark purple tongue,and enlarged tongue.The pulse frequency was wiry pulse,deep pulse,thin pulse,slippery pulse,weak pulse,unsmooth pulse,irregular pulse,slow pulse,and rapid pulse.3.Analysis of syndrome elements characteristics3.1 Extraction Results of Syndrome Elements in PatientsThere were six location syndrome elements of HFp EF patients in this study,which were heart,pulmonary,liver,spleen,kidney and xinshen.There are 11 nature syndrome elements,5of which are deficiency syndrome elements,including qi deficiency syndrome,yang deficiency syndrome,yin deficiency syndrome,blood deficiency syndrome and qi insecurity syndrome(insecurity syndrome);Six excess syndrome elements were phlegm syndrome,dampness,blood stasis syndrome,qi stagnation syndrome,yang hyperactivity syndrome and heat.3.2 The analysis of syndrome element characteristics of the enrolled patientsRegardless of age or BMI or NYHA cardiac function classification level,the location syndrome elements of HFp EF patients were mainly pulmonary,heart and liver,and the nature syndrome elements were mainly yang deficiency syndrome,qi deficiency syndrome,yin deficiency syndrome and phlegm syndrome,dampness.The correlation between them was strong,and most of them were combined.Among them,qi deficiency syndrome and yang deficiency syndrome were the most obvious.In gender comparison,the syndrome manifestations of liver syndrome,xinshen syndrome,blood deficiency syndrome and yang hyperactivity syndrome of women were all more obvious than men,and the differences were statistically significant(P<0.05 or P<0.01 or P<0.001).Heat syndrome of men was more common than women,the difference was statistically significant(P<0.05).There was no significant difference in weight distribution between genders(P>0.05).3.3 Analysis of syndrome element characteristics of patients before and after treatmentThere was no significant difference in the frequency and weight of each syndrome element between the two groups before treatment(P>0.05).Compared with the two groups after treatment,the weight distribution of syndrome elements of kidney syndrome,yin deficiency syndrome and phlegm syndrome between the two groups was statistically different(P <0.05).Compared before and after treatment,in addition to the heat syndrome,the weight difference of each syndrome element in the treatment group before and after treatment was statistically significant(P<0.05 or P<0.01 or P<0.001).4.Correlation analysis between syndrome elements and CPET index4.1 The analysis of syndrome elements and Weber cardiac function classificationRegardless of the Weber cardiac function classification level,the frequency and weight distribution of syndrome elements in different levels are roughly the same as the overall distribution.4.2 The analysis of syndrome elements and CPET indexs including cardiopulmonary function indexs,ventilation function indexs,heart rate indexs and blood pressure indexs(1)Pulmonary syndrome: peak metabolic equivalent(Peak MET),peak heart rate(Peak HR),change value of systolic blood pressure(△SBP),the ratio of change value of systolic blood pressure to peak metabolic equivalent(△ SBP/Peak MET),peak pulse pressure difference(Peak PP),and change value of pulse pressure difference(△PP)were negatively correlated with the performance of pulmonary syndrome,and the correlation coefficients were-0.260(P=0.048),-0.315(P=0.016),-0.277(P=0.036),-0.279(P=0.034),-0.336(P =0.010),and-0.390(P =0.002),respectively;(2)Heart syndrome: Peak MET,Peak minute ventilation(Peak VE),Peak HR,Peak systolic blood pressure(Peak SBP),△SBP,△SBP/Peak MET,Peak PP,△PP were negatively correlated with the performance of heart syndrome,the correlation coefficients were-0.281(P=0.032),-0.274(P=0.038),-0.294(P=0.025),-0.345(P=0.08),-0.327(P=0.012),-0.346(P=0.008),-0.419(P=0.001),-0.431(P=0.001),respectively;(3)Liver syndrome: Peak VE,the ratio of peak minute ventilation to maximum minute ventilation(Peak VE/MVV),Peak SBP,△SBP,△SBP/Peak MET,Peak PP,and △PP were negatively correlated with the performance of liver syndrome,and the correlation coefficients were-0.289(P=0.028),-0.322(P=0.014),-0.331(P=0.011),-0.273(P=0.038),-0.294(P=0.025),-0.396(P=0.002),and-0.291(P=0.027),respectively.Resting Pet CO2 was positively correlated with the performance of liver syndrome,with a correlation coefficient of0.364(P=0.005);(4)Qi deficiency syndrome: △PP was negatively correlated with the performance of Qi deficiency syndrome,the correlation coefficient was-0.307(P=0.019);The changes of Peak P and HRR1 at 1 min after exercise were negatively correlated with the improvement of Qi deficiency syndrome,and the correlation coefficients were-0.300(P=0.048)and-0.332(P=0.028),respectively;(5)Yang deficiency syndrome: Peak PP and △PP were negatively correlated with the performance of Yang deficiency syndrome,and the correlation coefficients were-0.290(P=0.027)and-0.310(P=0.018),respectively;The change of slope of ventilatory equivalent for carbon dioxide(VE/VCO2 slope)was positively correlated with the improvement of Yang deficiency syndrome,and the correlation coefficient was 0.341(P=0.023);(6)Yin deficiency syndrome: Peak VO2,Peak MET,Peak SBP,△SBP,△SBP/Peak MET,Peak DBP were negatively correlated with Yin deficiency syndrome,the correlation coefficients were-0.282(P=0.032),-0.280(P=0.033),-0.280(P=0.033),-0.306(P=0.019),-0.286(P=0.029),-0.286(P=0.030),respectively;(7)Phlegm syndrome : anaerobic threshold(AT),Peak VO2,Peak MET,Peak VE,Peak VE/MVV,Peak HR,heart rate change(△HR),Peak PP,△PP were negatively correlated with the performance of phlegm syndrome,the correlation coefficients were-0.281(P=0.032),-0.310(P=0.018),-0.349(P=0.007),-0.272(P=0.039),-0.300(P=0.022),-0.351(P=0.007),-0.309(P=0.018),-0.286(P=0.029),-0.284(P=0.031),-0.345(P=0.08),respectively;The changes of Peak VO2,the percentage of percentage of peak oxygen uptake in predicted value(Peak VO2%pred)and Peak MET were negatively correlated with the improvement of phlegm syndrome,and the correlation coefficients were-0.379(P=0.011),-0.418(P=0.005)and-0.330(P=0.028),respectively;(8)Dampness syndrome: Peak HR,△ HR were negatively correlated with the performance of dampness syndrome,the correlation coefficients were-0.292(P=0.026),-0.283(P=0.032),respectively;The changes of Peak VO2 and Peak VO2%pred were negatively correlated with the improvement of dampness syndrome,the correlation coefficients were-0.377(P=0.012),-0.413(P=0.005),respectively;There was no significant correlation between the other indexs and syndrome elements(P>0.05).Conclusion1.HFp EF is more common in the elderly,women,overweight and obesity.Hypertension is the most common comorbidity of HFp EF.2.TCM disease location syndromes of patients with HFp EF are mostly heart syndrome,pulmonary syndrome and liver syndrome.The nature syndrome elements embody "the original deficiency syndrome elements and the superficial excess syndrome elements",the deficiency syndrome elements are mainly qi deficiency syndrome,yang deficiency syndrome,and yin deficiency syndrome,and the excess syndrome elements are mainly phlegm syndrome and dampness syndrome.3.Routine western medicine with yangyin shuxin decoction to treat HFp EF is better than routine western medicine alone,and the safety is good.4.CPET has certain feasibility in the objective and quantitative evaluation of HFp EF TCM syndrome differentiation and curative effect evaluation,among which phlegm syndrome has higher application value,and the safety is good.