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The Application of TCM Inquiry Diagnosis in the Functional Classification of Heart Failure

Tieh-Cheng Fu  Yi-Chung Ling  Wei-Ling Chou  Ching-Mao Chang  Jong-Shyan Wang  Hen-Hong Chang  
【摘要】:Background Heart failure(HF) patients experience dyspnea,fatigue,and exercise intolerance,it resulted from myocardial pumping deficiency,which lead to reduced cardiac output and impaired blood perfusion in peripheral tissue,and further system dysfunction.The New York Heart Association(NYHA) Functional Classification provides a simple way of classifying the degree of HF.It places patients in one of the four categories based on how they are limited in their physical activity by subjective judgment.Traditional Chinese Medicine(TCM) use primitive senses to record information of patients' daily life activity for diagnosis.It's simple and safe,but difficult to quantify that is the same as NYHA Fc.In order to evaluate the efficacy of traditional Chinese medicine,TCM introduce scientific methods to assist diagnosis focus on standardization.Using cluster analysis on scales of questionnaire for clinical conditions,the framework of symptoms will appear.Some important symptoms will become the critical elements for diagnosis differentiation and it should be feasible to look for the critical parameters to differentiate Fc II Fc Ⅲ.Since the clinical presentation of HF is closely related to "Qi-deficiency" in TCM,the relationship of NYHA functional classification and the degree of "Qi-deficiency" is worthy of further observation.Exercise training in HF patients improves their cardiac function as well as blood perfusion and utilization in peripheral tissue,thereby promoting their aerobic capacity,and improving their quality of life.The effect of exercise is similar to "Qi rejuvenation".The effect of exercise on the clinical manifestations of HF patients should be able to synchronize or correlate with the important markers of the "Qi-deficiency" in TCM.Methods We recruit 60 HF patients from the department of cardiology in medial center,and classify them into the NYHA functional class Ⅱ or Ⅲ group according to their aerobic capacity in cardiopulmonary exercise test.All patients received exercise training for 30 minutes,three times per week for 12 weeks,and receive another CPET and TCM evaluation afterwards.We evaluate them by maximal oxygen uptake(peak V02),oxygen transport and utilization of skeletal muscle and brain during exercise,cardiac output(CO),BNP,Minnesota Living With Heart Failure Questionnaire(MLHFQ),SF-36,and TCM symptom questionnaire.Results There were 38 HF patients included into this study form 2013/02 to 2013/09,and 18 HF patients had been done the exercise training for the pilot results.The baseline data of left ventricular ejection fraction(LVEF) was 39.7%,and it elevated to 48.6%after 36 times exercise training.High correlation between SF-36 and MLHFQ was the result of this study.And we also found "panting on exertion", "abdominal distention", "lack of strength" and "insomnia" maybe the key factor of determination of differentiating the Fc Ⅱ Fc Ⅲ.Conclusion We expect to identify key symptoms for classification by data mining.We also plan to observe the effect of exercise training by following up these critical makers in patient with heart failure.

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