Nomogram-based risk assessment model for left ventricular hypertrophy in patients with essential hypertension: Incorporating clinical characteristics and biomarkers.

Left ventricular hypertrophy (LVH) is a hypertensive heart disease that significantly escalates the risk of clinical cardiovascular events. Its etiology potentially incorporates various clinical attributes such as gender, age, and renal function. From mechanistic perspective, the remodeling process of LVH can trigger increment in certain biomarkers, notably sST2 and NT-proBNP. This multicenter, retrospective study aimed to construct an LVH risk assessment model and identify the risk factors. A total of 417 patients with essential hypertension (EH), including 214 males and 203 females aged 31-80 years, were enrolled in this study; of these, 161 (38.6%) were diagnosed with LVH. Based on variables demonstrating significant disparities between the LVH and Non-LVH groups, three multivariate stepwise logistic regression models were constructed for risk assessment: the "Clinical characteristics" model, the "Biomarkers" model (each based on their respective variables), and the "Clinical characteristics + Biomarkers" model, which amalgamated both sets of variables. The results revealed that the "Clinical characteristics + Biomarkers" model surpassed the baseline models in performance (AUC values of the "Clinical characteristics + Biomarkers" model, the "Biomarkers" model, and the "Clinical characteristics" model were .83, .75, and .74, respectively; P < .0001 for both comparisons). The optimized model suggested that being female (OR: 4.26, P <.001), being overweight (OR: 1.88, p = .02) or obese (OR: 2.36, p = .02), duration of hypertension (OR: 1.04, P = .04), grade III hypertension (OR: 2.12, P < .001), and sST2 (log-transformed, OR: 1.14, P < .001) were risk factors, while eGFR acted as a protective factor (OR: .98, P = .01). These findings suggest that the integration of clinical characteristics and biomarkers can enhance the performance of LVH risk assessment.

Correlation between Characteristics of Coronary Plaque and Chinese Medicine Syndromes of Coronary Heart Disease: A Cross-Sectional Study Analysed by Intravascular Ultrasound.

OBJECTIVE: To analyse the correlation between the characteristics of coronary plaque in coronary heart disease (CHD) patients with phlegm-blood stasis syndrome (PBS) and blood stasis syndrome (BSS). METHODS: Patients were divided into different groups based on Chinese medicine (CM) syndrome differentiation. The baseline demographics and clinical variables were collected from the medical records. Additionally, the characteristics of plaque and pathological manifestations in coronary artery were evaluated using intravascular ultrasound (IVUS). RESULTS: A total of 213 CHD patients were enrolled in two groups: 184 were diagnosed with PBS and the remaining 29 were diagnosed with BSS. There were no significant differences in age, body mass index, proportions of patients with high blood pressure, diabetes mellitus, smoking, hyperlipidemia, history of coronary artery bypass graft and percutaneous coronary intervention, medications, index from cardiac ultrasound image, blood lipids and C-reactive protein between the two groups (P>0.05), except gender, weight and proportions of IVUS observed target vessels (P<0.05 or P<0.01). More adverse events such as acute myocardial infarction (P=0.003) and unstable angina (P=0.048) were observed in BSS. Additionally, dissection, thrombus and coronary artery ectasia were significantly increased in BSS (P<0.05 or P<0.01). In contrast, PBS had more patients with stable angina and chronic total occlusion with significantly higher SYNTAX (synergy between percutaneous coronary intervention with Taxus and coronary artery bypass surgery) scores (P<0.05 or P<0.01). Moreover, dense-calcium was significantly elevated in PBS (P<0.01). CONCLUSIONS: Coronary plaque characteristics were correlated with different CM syndromes. Patients with PBS were associated with a higher degree of calcified plaque and severe coronary artery stenosis, indicating poor clinical prognosis but with a low probability of acute coronary events. In contrast, the degree of calcified plaque in patients with BSS remained relatively low, and plaque was more vulnerable, resulting in the possibility of the occurrence of acute coronary events remaining high.

[Analysis of on medication rules for Qi-deficiency and blood-stasis syndrome of chronic heart failure based on data mining technology].

To analyze the medication features and the regularity of prescriptions of traditional Chinese medicine in treating patients with Qi-deficiency and blood-stasis syndrome of chronic heart failure based on modern literature. In this article, CNKI Chinese academic journal database, Wanfang Chinese academic journal database and VIP Chinese periodical database were all searched from January 2000 to December 2015 for the relevant literature on traditional Chinese medicine treatment for Qi-deficiency and blood-stasis syndrome of chronic heart failure. Then a normalized database was established for further data mining and analysis. Subsequently, the medication features and the regularity of prescriptions were mined by using traditional Chinese medicine inheritance support system(V2.5), association rules, improved mutual information algorithm, complex system entropy clustering and other mining methods. Finally, a total of 171 articles were included, involving 171 prescriptions, 140 kinds of herbs, with a total frequency of 1 772 for the herbs. As a result, 19 core prescriptions and 7 new prescriptions were mined. The most frequently used herbs included Huangqi(Astragali Radix), Danshen(Salviae Miltiorrhizae Radix et Rhizoma), Fuling(Poria), Renshen(Ginseng Radix et Rhizoma), Tinglizi(Semen Lepidii), Baizhu(Atractylodis Macrocephalae Rhizoma), and Guizhi(Cinnamomum Ramulus). The core prescriptions were composed of Huangqi(Astragali Radix), Danshen(Salviae Miltiorrhizae Radix et Rhizoma) and Fuling(Poria), etc. The high frequent herbs and core prescriptions not only highlight the medication features of Qi-invigorating and blood-circulating therapy, but also reflect the regularity of prescriptions of blood-circulating, Yang-warming, and urination-promoting therapy based on syndrome differentiation. Moreover, the mining of the new prescriptions provide new reference and inspiration for clinical treatment of various accompanying symptoms of chronic heart failure. In conclusion, this article provides new reference for traditional Chinese medicine in the treatment of chronic heart failure.

[Effect of clinical pathways based on integrative medicine for patients with chronic heart failure: a multi-center research].

OBJECTIVE: To assess a multi-center study effectiveness of clinical pathways based on integrative medicine (IM) for chronic heart failure (CHF) patients. METHODS: A combined method of historical control study and clinical study on concurrent control was used. After the standard management for clinical pathways was carried out in four hospitals at home, the effects on hospitalization days, medical expenses, clinical efficacy, patient satisfaction, and quality of life were assessed. RESULTS: Results of non-concurrent historical control study showed that: the hospital stay was significantly shorter in the pathways group than in the retrospective group (12.59 days vs 18.44 days), and the total cost of hospitalization was significantly reduced in the pathways group (yen 9 051.90 vs yen 11 978.40), showing statistical difference (P < 0.01). Moreover, the effect on the heart function was better in the pathways group than in the retrospective group (the markedly effective rate: 45.60% vs 21.90%; the total effective rate: 96.80% vs 86.10%), showing statistical difference (P < 0.01). Results of clinical study on concurrent control showed that the hospital stay was significantly shorter in the pathways group than in the control group (11.19 days vs 13.21 days), showing statistical difference (P < 0.05). The average total cost of hospitalization was significantly lower in the pathways group than in the control group (yen 8 656.80 vs yen 11 609.70), showing statistical difference (P < 0.01). As for clinical efficacy of Chinese medical syndrome, the total effective rate was higher in the pathways group than in the control group (97.10% vs 93.62%), showing statistical difference (P < 0.05). The markedly effective rate of heart function was better in the pathways group than in the control group, showing statistical difference (49.30% vs 38.30%, P < 0.05). The overall satisfaction was higher in the pathways group than in the conventional group (P < 0.01). There was no statistical difference in the mortality within 3 months after discharge from hospital, and the readmission rate due to heart failure between the two groups (P > 0.05). But there was statistical difference in the quality of life (P < 0.05). CONCLUSION: The pathway could shorten the hospitalization time, decrease the cost of hospitalization, improve the clinical efficacy, improve patients' quality of life and satisfaction, therefore, it could be spread nationwide.

[Clinical epidemiologic investigation on Chinese medicine syndrome laws in patients with chronic heart failure].

OBJECTIVE: To study the distribution laws of Chinese medicine syndromes in patients with chronic heart failure (CHF) by clinical epidemiologic investigation. METHODS: 512 CHF patients were studied, including 168 items of symptoms and 48 items of tongue and pulse pictures. A database of Chinese medicine syndromes was established, and 9 disease nature elements and 5 disease location elements were extracted. Frequency analysis was performed on all symptoms, tongue and pulse pictures. The variables with frequency constituent ratio less than 10.0% were deleted. Then the features of clinical epidemiology, syndrome patterns, syndrome elements, main symptoms, as well as tongue and pulse pictures were analyzed. RESULTS: (1) The disease nature elements of CHF covered qi deficiency, yin deficiency, and yang deficiency (categorized as the essential deficiency), as well as blood stasis, turbid phlegm, and the retained fluid (categorized to the superficiality excess). Among them, frequencies of qi deficiency and blood stasis (both more than 85.0%) were the highest. The disease location elements of CHF were ordered in frequency as Xin (97.9%), Pi (88.1%), followed by Shen (43.0%), Fei (30. 1%), and Gan (7.0%). (2) In the distribution of syndrome patterns in CHF patients, qi deficiency phlegm-stasis syndrome was the most (59.2%), followed by qi-yin deficiency with phlegm-stasis intermingle syndrome (20.3%), Xin-yang decline with phlegm-stasis obstruction syndrome (7.0%), and yang-deficiency with water overflowing syndrome (5.5%). (3) Patients with heart function grade II, III, and IV mainly manifested as qi-deficiency with phlegm-stasis syndrome. Besides, qi-yin deficiency with phlegm-stasis intermingle syndrome could be often seen in those with grade III. And Xin-yang decline with phlegm-stasis obstruction syndrome and yang-deficiency with water overflowing syndrome could often be seen in those with grade IV. CONCLUSIONS: The pathogenesis of CHF is essential deficiency and superficiality excess. The essentiality consists of qi deficiency, yin deficiency, and yang deficiency, and the superficiality consists of blood stasis, turbid phlegm, and retained fluid. The disease was located at the five zang-organs, mainly dominated at Xin and Pi, and associated with Fei, Shen, and Gan. Qi deficiency phlegm-stasis syndrome was dominated in Chinese medicine syndrome patterns. Along with the aggravation of CHF, Chinese medicine syndrome pattern shows certain development laws.

[Double blinded randomized and controlled study on treatment of chronic heart failure by nuanxin capsule].

OBJECTIVE: To evaluate the effect and safety of Nuanxin Capsule (NXC) in treating patients with chronic heart failure (CHF). METHODS: Adopting the randomized, positive controlled, double-blinded design, 150 CHF patients were assigned to the treatment group and the control group equally, they were treated with optimal western medical therapeutic scheme in combining respectively with NXC and placebo for 24 weeks. The indices for effectiveness and safety evaluation, such as Chinese medicine syndrome, grade of heart function, myocardial contraction, as well as the re-hospitalization rate and mortality, were observed. RESULTS: The total effective rate on heart function in the treatment group and the control group was 78.87% and 64.38% respectively, that on Chinese medicine syndrome was 85.9% and 63.0% respectively, comparisons of the two indices between the two groups all showed significant difference (P < 0.05, P < 0.01). And a better efficacy for improving patients' cardiac contraction function and quality of life was shown in the treatment group (P < 0.05, P < 0.01). The re-hospitalization rates in them were 23.9% and 53.4% respectively (P < 0.05), and 22.54% and 42.5% of the re-hospitalized patients had attack of acute heart failure, a significant difference was found between the two groups (P < 0.05). The mortality in them was 2.90% and 8.95% respectively, showing no significant difference between groups (P > 0.05). No obvious adverse effect was found in both groups. CONCLUSIONS: NXC could improve the heart function of patients, it has obvious curative effect and good safety in treating chronic heart failure.