Mirror-like tongue is an important predictor of acute heart failure: a cohort study of acute heart failure in Chinese patients

doi:10.19852/j.cnki.jtcm.20230904.004

Abstract

Abstract:

OBJECTIVE: To reveal that mirror-like tongue, observed via a noninvasive inspection, is a powerful indicator of the severity and prognosis of patients with acute heart failure (AHF).
METHODS: This was an observational, prospective study. A total of 408 patients who met the inclusion criteria and were diagnosed with AHF for the first time at Taicang Traditional Chinese Medicine Hospital Affiliated to Nanjing University of Chinese Medicine from August 2019 to January 2021 were selected as the research subjects. According to their tongue fur, the patients were divided into group A (mirror-like tongue group) and group B (non-mirror-like tongue group). The clinical characteristics and incidence of major adverse cardiovascular events (MACEs) within 1 year of follow-up were systematically compared between the two groups.
RESULTS: Sixty-five patients were included in group A, and 343 patients were included in group B. There were 32 males and 33 females in group A and 168 males and 175 females in group B. The average age of the overall population was 64 years old, and the average age of group A was significantly higher than that of group B (74 vs 62 years, P < 0.001). Compared with that in group B, the left ventricular ejection fraction (LVEF) in group A was significantly lower (35% vs 42%, P < 0.001), and the log N-terminal pro B-type natriuretic peptide (NT-proBNP) level was significantly higher (4.0 vs 3.4, P < 0.001). The proportion of the combined application of vasoactive drugs in group A was significantly higher than that in group B (64% vs 38%, P < 0.001). Group B had a higher proportion of coronary angiography (29.5% vs 16.9%, P = 0.038). Group A was more inclined to require mechanical ventilation than group B (33.9% vs 22.5%, P = 0.049). The length of hospital stay in group A was significantly longer than that in group B (13.1 vs 7.6, P < 0.001). The incidence of MACEs, such as recurrence of AHF, new myocardial infarction and stroke, in group A within one year was higher than that in group B (P = 0.007, 0.009, < 0.001). The incidence of cumulative MACEs in group A was significantly higher than that in group B [hazard ratio = 2.76, 95% confidence interval (1.73, 4.41), P < 0.001]. Univariate and multivariate Cox regression analyses showed that mirror-like tongue, age, length of stay, LVEF and log NT-proBNP were independent predictors of MACEs in patients with AHF within one year.
CONCLUSIONS: Noninvasive tongue inspection technology can be used as a powerful tool for assessing the severity of illness and predicting prognosis in patients with AHF. A mirror-like tongue is an independent risk factor for MACEs in patients with AHF during the first year and has a combination effect with age, length of hospital stay, ejection fraction and NT-proBNP on the occurrence of MACEs.

Key words: heart failure, risk factors, fur, Yin deficiency, cohort studies

CHEN Yunhu, YIN Moqing, FAN Lihua, JIANG Xuechun, ZHANG Tao, ZHU Xingyu, XU Hongfeng. Mirror-like tongue is an important predictor of acute heart failure: a cohort study of acute heart failure in Chinese patients[J]. Journal of Traditional Chinese Medicine, 2023, 43(6): 1243-1251.

Figures/Tables 8

Figure 1 Mirror-like tongue and normal tongue A: the typical mirror-like tongue in AHF patients, characterized by a complete lack of tongue fur and a glossy and clean surface with or without cracks; B: the tongue of another AHF patient, a lightred texture and thin white fur, is normal. AHF: acute heart failure.

Figure 2 Flow chart of the study MACE: major adverse cardiovascular event. Group A: mirror-like tongue group; Group B: non-mirror-like tongue group.

Table 1 Baseline clinical features

Clinical feature	All (n = 408)	Group A (n = 65)	Group B (n = 343)	P value
Demographics
Mean age (years, $\bar{x}$ ± s)	64±11	74±10	62±10	<0.001
Male [n (%)]	200 (49.01)	32 (49.23)	168 (48.97)	0.970
Medical history [n (%)]
Hypertension	141 (34.56)	23 (35.38)	118 (34.40)	0.879
Diabetes mellitus	102 (25.00)	18 (27.69)	84 (24.49)	0.585
Hyperlipemia	209 (51.23)	35 (53.85)	174 (50.72)	0.645
Gout	53 (12.99)	8 (12.31)	45 (13.12)	0.858
Stroke	40 (9.80)	7 (10.77)	33 (9.62)	0.775
Atrial fibrillation, atrial flutter	102 (25.00)	17 (26.15)	85 (24.78)	0.844
VT	88 (21.56)	13 (20.00)	75 (21.86)	0.737
CHD	92 (22.54)	13 (20.00)	79 (23.03)	0.592
Valvular heart disease	176 (43.14)	25 (38.46)	151 (44.02)	0.406
Asthma	46 (11.57)	6 (9.23)	40 (11.66)	0.570
COPD	49 (12.01)	8 (12.31)	41 (11.95)	0.936
Kidney failure	72 (17.64)	11 (16.92)	61 (17.78)	0.867
Anemia	188 (46.07)	27 (41.54)	161 (46.94)	0.423
Infection	67 (16.42)	9 (13.85)	58 (16.91)	0.541
Clinical signs
SBP (mm Hg, $\bar{x}$ ± s)	130±26	125±25	131±27	0.071
DBP (mm Hg, $\bar{x}$ ± s)	75±13	74±12	76±13	0.510
HR (bpm, $\bar{x}$ ± s)	87±21	88±22	86±21	0.424
RR (bpm, $\bar{x}$ ± s)	28±7	29±8	28±7	0.262
NYHA [n (%)]				0.909
Ⅲ	30 (7.35)	5 (7.69)	25 (7.29)
Ⅳ	378 (92.65)	60 (92.31)	318 (92.71)
Ⅰ or Ⅱ	0 (0.00)	0 (0.00)	0 (0.00)

Table 1 Baseline clinical features

Clinical feature	All (n = 408)	Group A (n = 65)	Group B (n = 343)	P value
Demographics
Mean age (years, $\bar{x}$ ± s)	64±11	74±10	62±10	<0.001
Male [n (%)]	200 (49.01)	32 (49.23)	168 (48.97)	0.970
Medical history [n (%)]
Hypertension	141 (34.56)	23 (35.38)	118 (34.40)	0.879
Diabetes mellitus	102 (25.00)	18 (27.69)	84 (24.49)	0.585
Hyperlipemia	209 (51.23)	35 (53.85)	174 (50.72)	0.645
Gout	53 (12.99)	8 (12.31)	45 (13.12)	0.858
Stroke	40 (9.80)	7 (10.77)	33 (9.62)	0.775
Atrial fibrillation, atrial flutter	102 (25.00)	17 (26.15)	85 (24.78)	0.844
VT	88 (21.56)	13 (20.00)	75 (21.86)	0.737
CHD	92 (22.54)	13 (20.00)	79 (23.03)	0.592
Valvular heart disease	176 (43.14)	25 (38.46)	151 (44.02)	0.406
Asthma	46 (11.57)	6 (9.23)	40 (11.66)	0.570
COPD	49 (12.01)	8 (12.31)	41 (11.95)	0.936
Kidney failure	72 (17.64)	11 (16.92)	61 (17.78)	0.867
Anemia	188 (46.07)	27 (41.54)	161 (46.94)	0.423
Infection	67 (16.42)	9 (13.85)	58 (16.91)	0.541
Clinical signs
SBP (mm Hg, $\bar{x}$ ± s)	130±26	125±25	131±27	0.071
DBP (mm Hg, $\bar{x}$ ± s)	75±13	74±12	76±13	0.510
HR (bpm, $\bar{x}$ ± s)	87±21	88±22	86±21	0.424
RR (bpm, $\bar{x}$ ± s)	28±7	29±8	28±7	0.262
NYHA [n (%)]				0.909
Ⅲ	30 (7.35)	5 (7.69)	25 (7.29)
Ⅳ	378 (92.65)	60 (92.31)	318 (92.71)
Ⅰ or Ⅱ	0 (0.00)	0 (0.00)	0 (0.00)

Table 2 Auxiliary inspection parameters (

\bar{x}

± s)

Parameter	All (n = 408)	Group A (n = 65)	Group B (n = 343)	P value
LVEF (%)	41.706±8.054	35.712±7.710	42.832±7.615	<0.001
Log NT-proBNP	3.501±0.469	4.018±0.354	3.400±0.027	<0.001

Table 2 Auxiliary inspection parameters ( $\bar{x}$ ± s)

Parameter	All (n = 408)	Group A (n = 65)	Group B (n = 343)	P value
LVEF (%)	41.706±8.054	35.712±7.710	42.832±7.615	<0.001
Log NT-proBNP	3.501±0.469	4.018±0.354	3.400±0.027	<0.001

Table 3 Hospitalization procedures

Procedure	All (n = 408)	Group A (n = 65)	Group B (n = 343)	P value
Combination of two or more vasoactive drugs [n (%)]	173 (42.40)	42 (64.62)	131 (38.19)	<0.001
Mechanical ventilation [n (%)]	99 (24.26)	22 (33.85)	77 (22.45)	0.049
CAG [n (%)]	112 (27.45)	11 (16.92)	101 (29.45)	0.038
Length of stay (days, $\bar{x}$ ± s)	8.5±3.6	13.1±3.6	7.6±2.9	<0.001

Table 3 Hospitalization procedures

Procedure	All (n = 408)	Group A (n = 65)	Group B (n = 343)	P value
Combination of two or more vasoactive drugs [n (%)]	173 (42.40)	42 (64.62)	131 (38.19)	<0.001
Mechanical ventilation [n (%)]	99 (24.26)	22 (33.85)	77 (22.45)	0.049
CAG [n (%)]	112 (27.45)	11 (16.92)	101 (29.45)	0.038
Length of stay (days, $\bar{x}$ ± s)	8.5±3.6	13.1±3.6	7.6±2.9	<0.001

Table 4 MACEs analysis [n (%)]

MACEs	All (n = 408)	Group A (n = 65)	Group B (n = 343)	P value
AHF recurred	103 (25.25)	25 (38.46)	78 (22.74)	0.007
New nonfatal MI	13 (3.19)	6 (9.23)	7 (2.04)	0.009
Stroke	14 (3.43)	8 (12.31)	6 (1.75)	<0.001
VT or VF	12 (2.94)	4 (6.15)	8 (2.33)	0.107
All-cause death	7 (1.72)	2 (3.08)	5 (1.46)	0.309

Table 5 Cox regression analysis

Variable	Univariate Cox regression analysis HR (95% CI)	P value	Multivariate Cox regression analysis HR (95% CI)	P value
Mirror-like tongue	2.452 (2.356, 2.553)	<0.001	2.341 (2.225, 2.462)	<0.001
Length of hospital stay (for every 1 day increase)	1.197 (1.193, 1.201)	<0.001	1.016 (1.010, 1.023)	<0.001
Age (for every 1 year increase)	1.124 (1.122, 1.126)	<0.001	1.028 (1.020, 1.036)	<0.001
LVEF (for every 1% increase)	0.830 (0.827, 0.832)	<0.001	0.929 (0.916, 0.942)	<0.001
log NT-proBNP (for every 1 unit increase)	16.454 (15.764, 17.175)	<0.001	4.279 (3.721, 4.922)	<0.001

Figure 3 Cumulative hazard of MACEs The incidence of cumulative MACEs in group A was significantly higher than that in group B [HR = 2.76, 95% CI (1.73, 4.41), Log-rank test P < 0.001]. MACEs: major adverse cardiovascular events; HR: hazard ratio; CI: confidence interval.

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