Syndrome Characteristics Of Chronic Heart Failure Complicated With Hypothyroidism And Their Correlation With Cardiac Function And Physical And Chemical Indicators

Background and literature review:Chronic heart failure(CHF)is a complex clinical syndrome characterized by dyspnea,fatigue,and fluid retention(pulmonary congestion,systemic congestion,and peripheral edema),as the result of various causes.In heart failure,the abnormal cardiac structure and/or function result in impaired ventricular systolic and/or diastolic function.Subclinical hypothyroidism(SCH)refers to only elevated serum thyroid stimulating hormone(TSH)and normal Total thyroxine(TT4)and Free thyroxine(FT4)levels.SCH affects the pathogenesis and prognosis of CHF.Reviewing the clinical and basic research literature of traditional Chinese and western medicine in recent 10 years,SCH can affect cardiac structure and function,nutrition,metabolism and blood coagulation function.Cardiac events and all-cause mortality of CHF complicated with SCH are increased.It is recommended to treart patients whose TSH levels are consistently higher than 10 mIU/L with replacement therapy.However,there was no consensus on whether to intervene in patients with TSH values 4.2 to 10 mIU/L.Levothyroxine replacement therapy did not treat cardiovascular risk factors,but increased metabolic demands of the heart,which may lead to new ischemia.Traditional Chinese Medicine considers that chronic heart failure complicated with SCH belongs to yang deficiency.The method of treatment to warmly invigorating spleen and kidney yang often obtains good effect.Lack of research on the syndrome distribution of chronic heart failure complicated with SCH,the current researches mainly focuse on yang deficiency syndrome,which is not consistent with that the most common syndrome of CHF is qi deficiency and blood stasis syndrome,and the most common syndrome of SCH is spleen and kidney qi deficiency syndrome.In addition,different syndromes,the objective indicators of the body are also different.The awareness of the distribution of syndromes of the disease is conducive to a more comprehensive understanding of the disease and improves the accuracy of treatment based on syndrome differentiation,to maximize the effectiveness of traditional Chinese medicine in the treatment of CHF complicated with SCH.Purpose:The purpose of this study is to explore the syndrome distribution characteristics of chronic heart failure with SCH,and whether there are differences in cardiac function grading and laboratory indexes among different syndromes,and to explore the influence of SCH on cardiac function grading and laboratory indexes in chronic heart failure,hoping to provide more bases for treatment based on syndrome differentiation of chronic heart failure complicated with SCH,so as to formulate a more reasonable intervention strategy of integrated traditional Chinese and western medicine.Methods:150 chronic heart failure patients with SCH hospitalized in China-Japan Friendship Hospital from January 2018 to January 2021 were enrolled as the group of SCH in the study.At the same time,150 chronic heart failure patients with normal thyroid function were collected as the control group.The information such as medical history,NYHA cardiac function grading,laboratory indexes and syndrome of TCM were collected to explore the syndrome distribution characteristics of chronic heart failure complicated with SCH,and to compare the differences of cardiac function grading among different syndromes.Also,to explore the correlation between syndrome distribution and laboratory indexes such as blood pressure,BMI,renal function,blood lipid and cardiac ultrasound index,and to explore the influence of SCH on cardiac function grading and laboratory indexes in chronic heart failure.SPSS20.0 statistical software was used for statistic analysis.Pearson ?2 test or Fisher exact probability method was used to compare the constituent ratio of categorical variables.Twosample t-test for independent samples or non-parametric test was used to compare the differences between the two groups of measurement data.If the dependent variable is categorical variable and the independent variables are categorical variables or continuous variables,Logistic regression analysis is used.The correlation between the two measurement data was compared by Pearson correlation analysis or Spearman correlation analysis.Results:(1)In this study,150 chronic heart failure patients with SCH and 150 chronic heart failure patients with normal thyroid function were included,including 150 males and 150 females.There was no significant difference in age and comorbidities between the two groups(P>0.05).In the SCH group,59.0%were overweight and obese,the most common comorbidities were hypertension and coronary atherosclerotic heart disease.(2)Oppression in chest,Shortness of breath,weakness,easy fatigue after activity,greenish or dim complexion,lips and limbs,ecchymosis on tongue and sublingual varices,deep pulse,stringy pulse or slippery pulse were the most common symptoms in both the SCH group and the control group.Some symptoms constituent ratio had statistically significant differences between the two groups(P<0.05).These symptoms included oppression in chest,easy fatigue after activity,greenish or dim complexion,lips and limbs,deep pulse,stringy pulse or slippery pulse.(3)In the group of SCH,7 cases were deficiency syndrome,7 cases were positive syndrome,136 cases belonged to the syndrome of intermingled deficiency and excess,accounting for 90.7%.Among the 150 patients,6 cases had single syndrome type,and the rest 144 cases were concurrent syndromes.The most common syndromes were qi deficiency and blood stasis syndrome(24 cases,16.0%)and qi deficiency and intermingled phlegm and stasis syndrome(18 cases,12.0%).98 cases(65.3%)had both qi deficiency syndrome and blood stasis syndrome.In the SCH group,qi deficiency syndrome was the mainly deficiency syndrome,and the mainly excess syndromes were blood stasis syndrome and phlegm-turbidity syndrome.In the control group,the mainly deficiency syndromes were qi deficiency syndrome and yang deficiency syndrome,and the mainly excess syndromes were blood stasis syndrome and fluid retention syndrome.Qi deficiency syndrome and blood stasis syndrome were the most common syndromes both in the SCH group and the control group.(4)In chronic heart failure patients with SCH,there were statistically significant differences in NYHA cardiac function grading between qi deficiency syndrome and non-qi deficiency syndrome,between yang deficiency syndrome and non-yang deficiency syndrome,and between fluid retention syndrome and non-fluid retention syndrome(P<0.05).Multivariate Logistic regression analysis showed that age was a risk factor for grade ?,grade? and grade ? of cardiac function in patients with chronic heart failure complicated with SCH,and fluid retention syndrome was a risk factor for cardiac function grade ?,taking NYHA cardiac function grade ? as the reference category.(5)In chronic heart failure patients with SCH,the difference of systolic blood pressure between qi deficiency syndrome and non-qi deficiency syndrome was statistically significant(P<0.05).The proportion of renal insufficiency and the TSH values had statistically significant differences between yang deficiency syndrome and non-yang deficiency syndrome(P<0.05).The proportion of peripheral vascular disease was significantly different between blood stasis syndrome and non-blood stasis syndrome(P<0.05).There were significant differences in the proportion of atrial fibrillation,hyperuricemia and renal insufficiency between fluid retention syndrome and non-fluid retention syndrome(P<0.05).The BMI,blood pressure,uric acid,TT4,left atrial diameter and interventricular septum thickness were significantly different between phlegm-turbidity syndrome and non-phlegm-turbidity syndrome(P<0.05).(6)There were statistically significant differences in syndrome constituent ratio of deficiency syndrome and the excess syndrome between the SCH group and the control group(P<0.05).There was no significant difference in the constituent ratio of cardiac function grading between two groups.Patients with cardiac function grade II or above accounted for 84.0%in the SCH group and 78.7%in the control group.Binary Logistic regression analysis showed that female(regression coefficient=0.629,OR=1.876)was a risk factor for CHF patients with SCH,and diastolic blood pressure(regression coefficient=-0.026,OR=0.975)was a protective factor for CHF patients with SCH.Conclusions:(1)Most of the chronic heart failure patients with SCH belonged to the syndrome of intermingled deficiency and excess.The most common syndromes were qi deficiency and blood stasis syndrome and qi deficiency and intermingled phlegm and stasis syndrome.Qi deficiency and blood stasis syndrome were the most common syndrome factors,and 65.3%of the patients in SCH group had both qi deficiency syndrome and blood stasis syndrome.(2)In chronic heart failure patients with SCH,NYHA cardiac function grading,comorbidities,and cardiac ultrasound indexes differer from different TCM syndromes.(3)There were differences in clinical symptoms and syndrome distribution between the SCH group and the control group.Female(regression coefficient=0.629,OR=1.876)was a risk factor for CHF patients with SCH,and diastolic blood pressure(regression coefficient=-0.026,OR=0.975)was a protective factor for CHF patients with SCH.In patients with chronic heart failure,the lower the diastolic blood pressure,the more common Subclinical hypothyroidism.