| Background: Heart Failure with Preserved Left Ventricular EjectionFraction(HFPEF), also called Diastolic Heart Failure (DHF), refers to the clinicalsyndrome that patients could maintain normal ventricular systolic function, but havedecreased ventricular relaxation and compliance and increased stiffness, thus leading toprogressive pulmonary or systemic congestion due to the reduction of ventricular fillingand elevated filling pressure. Doughterty firstly reported the disease in1984. However, inrecent years, the number of patients diagnosed with HFPEF has gradually increased,accounting for30%or50%of heart failure patients. Therefore, HFPEF has become a hotresearch in fundamental and clinical studies in recent years. Exploring effective treatmentmethods to intervene the progression of heart failure patients with HFPEF and preventingventricular remodeling is of great significance in improving the prognosis.Objective: The thesis explores short-term efficacy of Diltiazem joint Qi Li QiangXin Capsule in the treatment of heart failure with preserved left ventricular ejectionfraction (HFPEF) and analyses the efficacy and security of the combined treatment oftraditional Chinese and western medicine. Through the analysis of HFPEF patients’cardiac function, brain serum BNP (B-type natriuretic peptide) and the indicators of UCG(ultrasonic cardiography): E (mitral diastolic velocity at early peak), A (mitral diastolic velocity at late peak), E/A (the ratio of mitral diastolic velocity at early peakand mitral diastolic velocity at late peak) before and after treatment, the thesis measuresmitral annular diastolic velocity at early peak (Em), mitral annular diastolic velocity atlate peak (Am) for three times and takes the average of the three measuring results, thencalculates the ratio of mitral annular diastolic velocity at early peak (Em) and mitralannular diastolic velocity at late peak (Em/Am), adding clinical observation andinvestigation before and after treatment and compares the diastolic function and treatingeffects of patients with heart failure after the treatment between the diltiazem group andtraditional medicine group, Diltiazem joint Qi Li Qiang Xin Capsule group andtraditional medicine group and Diltiazem joint Qi Li Qiang Xin Capsule group andDiltiazem group with the aim at creating a new therapy of treating the disease through thecombination of traditional Chinese and western medicine.Methods: The thesis selects diagnosed98patients with HFPEF at the age from40to75(the standard of LVEF value retention is EF>45%). Then three groups arerandomly divided. Group A (traditional medicine group) is only treated by traditionalanti-heart failure medicine (ACEI/ARB drugs, digitalis, diuretics, lipid nitric acid, β-blockers, etc.)with32patients (18male,14female) at the age of56plus or minus11.5; In group B (Diltiazem group), Diltiazem (15-30mg/time,3times/day) is givento treat33patients (16male,17female)at the age of59plus or minus7.0on the basisof group A; In group C (group of Diltiazem joint Qi Li Qiang Xin Capsule), on the basisof group A (group of traditional medicine), Diltiazem (15-30mg/time,3times/day)andQi Li Qiang Xin Capsule (1.2g/time,3times/day) are given to the33patients (15male,18female) at the age of58plus or minus8.1. There is no distinguished differences(p>0.05) in the aspect of age structure and sex percentage in the patients of the threegroups. The patients’ cardiac function is respectively assessed24hours after admissionbefore treatment and eight weeks after treatment and the serum BNP level of all patientsis measured. The cardiac ultrasound indicators, E (bicuspid lobe diastolic velocity atearly peak), A (bicuspid lobe diastolic velocity at late peak), E/A (the ratio of bicuspid lobe diastolic velocity at early peak and bicuspid lobe diastolic velocity at late peak), ofall the involved patients are measured within48hours of admission and8weeks aftertreatment. Three sets of data before and after treatment are checked by matched t-test,then the writer counts the material and describes the number and percentage of patients ineach group. The present author mainly adopts chi-square test and one-way ANOVAanalysis to compare the three groups and all the test data is presented by_x_±s. With thehelp of software SPSS20.0statistical analysis, statistical differences is p <0.05.Results:1Through the data analysis of Table2,the patients’ cardiac function ofthree groups improves greatly. Here is the improvement of cardiac function8weeks afteradmission. In group A,6cases are markedly effective and8cases are effective.Therefore, the total efficiency of group A is43.8%; In group B,9cases are markedlyeffective and13cases are effective. Therefore, the total efficiency of group B is66.7%;In group C,14cases are markedly effective and17cases are effective. Therefore, thetotal efficiency of group C reaches93.9%. The chi-square test is used to check the dataof the three groups and the result is χ2=18.990a, p <0.01. This data illustrates thatpatients’cardiac function of three groups is greatly improved after8weeks of treatmentand the differences have great significance in statistics. Segmentation method ofchi-square is adopted to compare group B and group C and the result is χ2=7.759a, p=0.005<0.017. This difference has significance in statistics. Through the comparison ofgroup A with group C, the result is χ2=19.211a, p <0.01. This difference also hassignificance in statistics. Through the comparison of group A with group B, the result isχ2=3.453a, p=0.63>0.17, the difference has no significance in statistics. To sum up,the difference between group A and group B has no significance in statistics, while boththe difference between group A and group C and group B and group C has significance instatistics. The result shows that the therapy of group C, that is, combining Diltiazem withQi Li Qiang Xin Capsule to improve HFPEF patients’ cardiac function, is significantlybetter than the therapy of group A (traditional treatment group) and group B (Diltiazemgroup). There is no marked statistical difference between group A (traditional treatment group) and group B (Diltiazem group) in improving cardiac function.2Through thedata analysis of Table3, the comparison of BNP concentrations in all the above threegroups of patients with HFPEF before treatment and after treatment is as follows. Thedata of group A is490.56±105.17(pg/ml) before treatment, while the data of group Abecomes433.06±76.18(pg/ml) after the treatment. The difference can be shown byt=2.502，P=0.015<0,05, Therefore the difference before the treatment and after treatmentwas statistically significant; The data of group B is483.30±121.33(pg/ml) beforetreatment, while the data of group B becomes319.91±73.14(pg/ml) after the treatment.The difference can be shown by t=6.625，P=0.000<0.05, so the difference was verystatistically significant; The data of group C is483.45±119.66(pg/ml) before treatment,while the data of group C becomes243.64±102.58(pg/ml)after the treatment. Thedifference can be shown by t=8.741， P=0.000<0.05, so the difference was verystatistically significant. The above data shows that patients’ BNP levels of three groupsreduce after treatment. Compared with group A and group B, BNP level of group C has asharper fall. BNP level of three groups is analyzed by one-way ANOVA method8weeksafter treatment. The difference is F=40.69,p=0.000<0.05, so the differences among threegroups was very statistically significant. Comparing group A with group B, the differenceis p=0.042<0.05; Comparing group B with group C, the difference is p=0.035<0.05;Comparing group A with group C, the difference is p=0.000<0.01.The data shows thatdifference between all the three groups is statistically significant, and the differencebetween group A and group C is much more significant.The result shows that the therapyof group C, that is, combining Diltiazem with Qi Li Qiang Xin Capsule to improveHFPEF patients’ BNP level, is significantly better than the therapy of group A(traditional treatment group) and group B (Diltiazem group).3.From data analysis ofTable-4, all the indicators of the three groups with HFPEF are P>0.05. This result showsthat there is not apparent differences in the three indicators before and after treatment, sothe indicators are compaable. The E indicator in the comparison between groups beforetreatment and after treatment is p=0.00<0.05, so there is statistical significance in the three groups. The A indicator in the three groups before and after treatment has nostatistical significance in group A, but has statistical significance in both group B andgroup C. The E/A indicator has statistical significance in the comparison between groups.The Em indicator in the comparison between groups is p<0.05, so there is statisticalsignificance in all the three groups. The Am indicator in group A is t=1.481,p=0.144>0.05, so there is no statistical significance in the above group A before and aftertreatment. The Am indicator in both group B and group C is p<0.05, so there is statisticalsignificance in both group B and group C. The Em/Am indicator in all the comparisonbetween groups is p<0.05, so all the comparison of the three groups do have statisticalsignificance. All the indicators in the comparison between groups are as follows. The Eindicator is F=27.16, P=0.000<0.05, and the data of comparison between groups is allP<0.05, so there is statistical significance in the three groups. The A indicator is F=6.08,P=0.003<0.05. The data of the comparison between group A and group B isP=0.112>0.05, so there is no statistical significance in group A and group B. The data ofthe comparison between group B and group C is P=0.062>0.05, so there is no statisticalsignificance in group B and group C. The data of the comparison between group A andgroup C is P=0.001<0.05, so there is statistical significance in group A and group C. TheE/A indicator is F=31.13, P=0.000<0.05, and the data of comparison between groups isP<0.05, so there is statistical significance in the three groups. The Em indicator isF=16.23, P=0.000<0.05, and the data of comparison between groups is P=0.000<0.05, sothere is statistical significance in the three groups. The Am indicator is F=31.41,P=0.000<0.05, and the data of comparison between groups is P=<0.05, so there isstatistical significance in the three groups. The Em/Am indicator is F=37.89,P=0.000<0.05,and the data of comparison between groups is P<0.05, so there isstatistical significance in the three groups. To sum up, in the improvement of theindicators of FHPEF patients, the treatment of group C is better than group A and groupB, and group B is better than group A. Therefore, to combine Diltiazem and Qi Li QiangXin Capsule on the basis of traditional treatment is more efficient in the treatment of FHPEF patients.Conclusion: The traditional treatment group (group A), Diltiazem (group B) andthe combination of Diltiazem and Qi Li Qiang Xin Capsule group (group C) could allimprove cardiac function of HFPEF patients’ grade, lowering patients’ BNP levels andimprove diastolic function. The combination of traditional medicine with Diltiazem isbetter than traditional medicine. Moreover, the combination of Diltiazem and Qi LiQiang Xin Capsule will have more effective therapy in the treatment of HFPEF patients.Therefore, the thesis holds that on the basis of traditional medicine therapy towardsHFPEF patients, the application of Qi Li Qiang Xin Capsule and Diltiazem can furtherimprove the treatment of the disease. So the method is worthy of clinical spreading. |
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