Ultrasonic Evaluation Of Chronic Left Heart Failure Complicated With Pulmonary Hypertension And Study Of TCM Syndrome Pattern Distribution

Objective: By collecting the case data of patients with chronic left heart failure complicated with pulmonary hypertension,the characteristics of various echocardiographic indicators were compared and analyzed,in order to find the ultrasonic indicators that can provide clinical reference for the prevention and treatment of the disease.At the same time,the distribution rules of TCM syndromes of this disease were summarized to provide reference for the TCM syndrome differentiation of patients with chronic left heart failure complicated with pulmonary hypertension.Methods: In this thesis,a retrospective analysis was conducted to collect medical records of patients hospitalized with chronic left heart failure in our hospital from January 2017 to December 2021 according to inclusion/exclusion criteria.General data,echocardiographic indicators and TCM syndrome types were recorded into Excel tables for integration to form a database.Groups were grouped according to whether pulmonary hypertension was combined.SPSS25.0 was used for statistical analysis,and P<0.05 meant the difference was statistically significant.Result:(1)General information: Compared with no pulmonary hypertension,HFp EF and HFr EF combined with pulmonary hypertension showed no significant difference in age and gender distribution(P>0.05).The incidence of hypertension and atrial fibrillation in patients with HFp EF combined with pulmonary hypertension was higher than that in patients without pulmonary hypertension(P<0.05),and there was no significant difference in complications in patients with HFr EF combined with pulmonary hypertension(P>0.05).The cardiac function grades of both HFp EF and HFr EF combined with pulmonary hypertension were higher than those without(P<0.05).(2)Echocardiogram indicators: At the end of diastole,left atrial anteroposterior diameter,right atrial upper and lower diameter,right atrial anteroposterior diameter,right ventricular anteroposterior diameter and E/e ’in HFp EF combined with pulmonary hypertension group were significantly higher than those in non-pulmonary hypertension group(P < 0.05),and right atrial anteroposterior diameter RA-D2[OR=1.143,95%CI(1.056-1.238).P=0.001],E/e ’[OR=1.136,95%CI(1.061-1.217),P=0.000] were risk factors for pulmonary hypertension caused by HFp EF,and were positively correlated with the incidence of pulmonary hypertension.There were no significant differences in left ventricular ejection fraction,left ventricular anteroposterior diameter at end of diastole,ventricular septal thickness and ascending aorta diameter(P>0.05).The left ventricular ejection fraction(LVEF)of HFr EF with pulmonary hypertension was significantly lower than that of HFREF without pulmonary hypertension(P<0.05).The end-diastolic diameter of left atrium,anteroposterior diameter of left ventricle,anteroposterior diameter of right atrium,anteroposterior diameter of right atrium,anteroposterior diameter of right atrium and anteroposterior diameter of right ventricle and E/e ’in HFr EF group with pulmonary hypertension were significantly higher than those in HFREF group without pulmonary hypertension(P<0.05),and E/e’ [OR=1.235,95%CI(1.088-1.402).P=0.001] was a risk factor for pulmonary hypertension in HFr EF,and was positively correlated with the incidence of pulmonary hypertension.There were no significant differences in end-diastolic septal thickness and ascending aorta diameter(P>0.05).(3)TCM syndrome type: The distribution proportions of Qi and Yin deficiency and Yang deficiency and water attack in patients with HFp EF and HFr EF combined with pulmonary hypertension were higher than those without pulmonary hypertension group(P < 0.05).The comparison of echocardiographic ICONS of different syndrome types showed that PASP level of Yang deficiency syndrome with water syndrome was significantly higher than that of other syndrome types(P<0.05),and there was no statistical significance in other echocardiographic indexes of different syndrome types(P>0.05).Conclusion:(1)HFp EF combined with pulmonary hypertension has a higher incidence of hypertension and atrial fibrillation,so clinical monitoring of blood pressure and heart rhythm should be strengthened.(2)E/e ’in echocardiography is a risk factor for pulmonary hypertension in HFp EF and HFr EF.The higher the E/e’ level is,the more likely it is to develop pulmonary hypertension.Right atrial diameter(RA-D2)is a risk factor for pulmonary hypertension in HFp EF,and is positively correlated with the incidence of pulmonary hypertension.It is suggested that the level of E/e ’and RA-D2 should be monitored in patients with chronic left heart failure.(3)Both HFp EF and HFr EF combined with pulmonary hypertension will lead to the development of TCM syndroms from qi deficiency and blood stasis to Qi deficiency and Yin deficiency or Yang deficiency and water attack;The PASP level of different TCM syndrome types is different,and the PASP level of Yang deficiency syndrome with water attack is significantly higher than that of other TCM syndrome types.PASP level can be used as an auxiliary syndrome differentiation index to evaluate TCM syndrome types of patients.