Analysis Of Correlation Between H2FPEF Score And TCM Syndrome Type And Prognosis In Patients With Ejection Fraction Retention Heart Failure

Objective:To analyze the prognostic assessment value of H2 FPEF score in patients with heart failure with preserved ejection fraction(HFp EF)by observing the correlation between H2 FPEF score and TCM syndrome and prognosis in patients with HFp EF..Methods:A total of 246 consecutive HFp EF patients who met the inclusion criteria and were hospitalized in the cardiology department of Quanzhou Hospital of Fujian University of Traditional Chinese Medicine from January 2021 to December 2022 were retrospectively analyzed.TCM syndrome differentiation was performed according to the four diagnostic methods of TCM,and the patients were divided into qi deficiency with blood stasis syndrome,qi and yin deficiency with blood stasis syndrome,and yang deficiency with blood stasis syndrome.The H2 FPEF score was calculated,and the correlation between the H2 FPEF score,TCM syndrome,and prognosis in HFp EF patients was observed.Result:1.A total of 246 HFp EF patients were included in the study,with a mean age of71.74±13.00 years,including 112 males(45.5%)and 134 females(54.5%).The qi deficiency with blood stasis syndrome was diagnosed in 91 patients(36.99%),qi and yin deficiency with blood stasis syndrome in 88 patients(35.77%),and yang deficiency with blood stasis syndrome in 67 patients(27.24%).Among them,30 patients(12.20%)were in NYHA class I,60(24.39%)were in NYHA class II,80(32.52%)were in NYHA class III,and 76(30.89%)were in NYHA class IV.The patients with yang deficiency with blood stasis syndrome were the oldest,while the patients with qi deficiency with blood stasis syndrome mainly had NYHA class I and II heart function,and those with qi and yin deficiency with blood stasis syndrome and yang deficiency with blood stasis syndrome mainly had NYHA class III and IV heart function(P<0.05 for all).2.The most common comorbidity among HFp EF patients was hypertension,followed by atrial fibrillation(AF),coronary heart disease,ischemic stroke,diabetes,and anemia.The proportion of HFp EF patients with hypertension was lower in those with qi deficiency with blood stasis syndrome than in those with qi and yin deficiency with blood stasis syndrome(P<0.05),and the proportion of patients with coronary heart disease and ischemic stroke was the lowest(P<0.05);the proportion of patients with AF and diabetes was highest in those with qi and yin deficiency with blood stasis syndrome(P<0.05).3.The patients with qi deficiency with blood stasis syndrome who were enrolled had the lowest levels of N-terminal pro-B-type natriuretic peptide(NT-pro BNP)and pulmonary artery systolic pressure(PASP)(P<0.05),and a lower left ventricular mass index(LVMI)compared to those with qi and yin deficiency with blood stasis syndrome.The patients with qi and yin deficiency with blood stasis syndrome had the highest left atrial volume index(LAVI)(P<0.05)and a higher E/e’(ratio of early diastolic mitral inflow velocity to early diastolic mitral annulus velocity)compared to those with qi deficiency with blood stasis syndrome(P<0.05).4.The highest H2 FPEF score was 9 and the lowest was 0,with a mean score of4.46±1.83.The H2 FPEF scores were qi and yin deficiency with blood stasis syndrome > yang deficiency with blood stasis syndrome > qi deficiency with blood stasis syndrome(P<0.05).Patients with qi and yin deficiency with blood stasis syndrome had the lowest body mass index(BMI)level(all P<0.05),a smaller proportion of obese patients than patients with qi deficiency with blood stasis syndrome(P<0.05),and a larger proportion of hypertensive patients with ≥2 oral antihypertensive drugs,PASP >35 mm Hg,and E/e’ >9 than patients with qi deficiency with blood stasis syndrome(P<0.05 for all);the largest proportion of patients with yang deficiency with blood stasis syndrome were aged >60 years(P<0.05 for all).5.Within 12 months of follow-up of HFp EF patients,45 patients(18.29%)were readmitted for heart failure,9 patients(9.89%)with qi deficiency with blood stasis,23patients(26.14%)with qi and yin deficiency with blood stasis,and 13 patients(19.40%)with yang deficiency with blood stasis.After multifactorial binomial logistic regression analysis,qi and yin deficiency with blood stasis syndrome,H2 FPEF score,and age were found to be independent risk factors for readmission in patients with HFp EF(P<0.05 for all).Conclusion:1.H2 FPEF score,qi and yin deficiency with blood stasis syndrome,and age were independent risk factors for readmission for heart failure within 12 months in patients with HFp EF.2.The H2 FPEF score scores of patients with the three TCM syndrome,in descending order,were qi and yin deficiency with blood stasis syndrome,yang deficiency with blood stasis syndrome,and qi deficiency blood stasis syndrome,which could guide the risk of readmission of HFp EF patients with different evidence types to some extent,among which patients with qi and yin deficiency with blood stasis syndrome had the greatest risk of readmission.