Spectrum of valvular lesions in newly diagnosed rheumatic heart disease

Authors

  • M. Saidul Alam Department of Cardiology, National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, Bangladesh
  • M. Arifur Rahman Department of Cardiology, National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, Bangladesh
  • M. Fazlul Karim Department of Cardiology, Sheikh Hasina Medical College, Jamalpur, Bangladesh
  • Khadeza Khatun Department of Microbiology, National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, Bangladesh
  • Mohammad Abdul Hye Department of Pediatrics, Magura Medical College, Magura, Bangladesh
  • Shirajum Munira Department of Pediatrics, Magura Medical College, Magura, Bangladesh
  • Sanjay Kumar Raha Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh
  • Smriti Kana Biswas 250 Bedded TB Hospital, Shyamoli, Dhaka, Bangladesh
  • Mohammad Jobayer Department of Microbiology, National Center for Control of Rheumatic Fever and Heart Diseases, Dhaka, Bangladesh

DOI:

https://doi.org/10.18203/2320-6012.ijrms20232511

Keywords:

Aortic regurgitation, Echocardiography, Mitral regurgitation, Rheumatic heart disease, Valvular lesions

Abstract

Background: Rheumatic heart disease (RHD) is the most common acquired heart disease among young adults and an important health problem in developing countries. There is much scarcity of information about echocardiographic evaluation of valvular involvement of RHD in Bangladesh. Objective of this study was to analyze the clinical spectrum and pattern of cardiac valvular lesions in newly diagnosed RHD patients.

Methods: This cross-sectional study was conducted from April 2019 to May 2021 in National Center for Control of Rheumatic Fever and Heart Diseases (NCCRF and HD), Dhaka, Bangladesh.  Newly diagnosed 160 RHD patients irrespective of age and sex were enrolled. Medical history was obtained, physical examination was carried out, several investigations were done and standard color Doppler echocardiography was performed. Diagnosis of RHD was made following 2012 World Heart Federation criteria.

Results: More than 60% of newly diagnosed patients of RHD were female; mean age of patients was 24.29±9.17 years and 77.5% of patients were between 15-34 years of age. Detected valvular lesions were mostly isolated (65%) and mitral valve involvement was 88.7%. Isolated mitral regurgitation was detected among 56.3% patients and was higher in female. Combination of mitral regurgitation and mitral stenosis were reported in 12.5% cases whereas mitral regurgitation with aortic regurgitation was present in 10.6% cases. Overall, 14 (6.4%) of the newly diagnosed patients were detected with severe forms of cardiac valvular lesion.

Conclusions: RHD were common in young adults. Mitral valve was predominantly involved, particularly presenting as isolated mitral regurgitation.

References

Noubiap JJ, Agbor VN, Bigna JJ, Kaze AD, Nyaga UF, Mayosi BM. Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies. Sci Rep. 2019;9(1):17022.

Singha CK, Khaled FI, Mahabub SM, Joarder AI, Arzu J, Adhikary DK, et al. Echocardiographic Assessment of Valvular Involvement in Chronic Rheumatic Heart Disease in BSMMU, Bangladesh. Mymensingh Med J. 2022;31(1):149-53.

Rheumatic Heart Disease. World Heart Federation. Available at: https://world-heart-federation.org/what-we-do/rheumatic-heart-disease. Accessed on 28 January 2023.

Ou Z, Yu D, Liang Y, Wu J, He H, Li Y, et al. Global burden of rheumatic heart disease: trends from 1990 to 2019. Arthritis Res Ther. 2022;24(1):138.

McCall C. Rheumatic heart disease in the Pacific Island nations. Lancet. 2018;391(10124):926.

Mensah GA, Roth GA, Sampson UK, Moran AE, Feigin VL, Forouzanfar MH, et al. Mortality from cardiovascular diseases in sub-Saharan Africa, 1990-2013: a systematic analysis of data from the Global Burden of Disease Study 2013. Cardiovasc J Afr. 2015;26:S6-10.

Zaman MM, Choudhury SR, Rahman S, Ahmed J. Prevalence of rheumatic fever and rheumatic heart disease in Bangladeshi children. Indian Heart J. 2015;67(1):45-9.

Remenyi B, Carapetis J, Wyber R, Taubert K, Mayosi BM, World Heart Federation. Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease. Nat Rev Cardiol. 2013;10(5):284-92.

Reményi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline. Nat Rev Cardiol. 2012;9(5):297-309.

Laudari S, Subramanyam G. A study of spectrum of rheumatic heart disease in a tertiary care hospital in Central Nepal. Int J Cardiol Heart Vasc. 2017;15:26-30.

Lawrence JG, Carapetis JR, Griffiths K, Edwards K, Condon JR. Acute rheumatic fever and rheumatic heart disease: incidence and progression in the Northern Territory of Australia, 1997 to 2010. Circulation. 2013;128(5):492-501.

Khan RF, Imtiaz Y, Ali H, Khan MU, Ali M, Riaz N, et al. Natural history and relative distribution of different valvular heart disease in Mayo Hospital, Lahore. Ann King Edward Med Univ. 2002;8(2):90-91.

Rothenbühler M, O’Sullivan CJ, Stortecky S, Stefanini GG, Spitzer E, Estill J, et al. Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents. Lancet Glob Health. 2014;2(12):e717-26.

Sliwa K, Carrington M, Mayosi BM, Zigiriadis E, Mvungi R, Stewart S. Incidence and characteristics of newly diagnosed rheumatic heart disease in urban African adults: insights from the heart of Soweto study. Eur Heart J. 2010;31:719-27.

Okello E, Wanzhu Z, Musoke C, Twalib A, Kakande B, Lwabi P, et al. Cardiovascular complications in newly diagnosed rheumatic heart disease patients at Mulago Hospital, Uganda. Cardiovasc J Afr. 2013;24(3):80-5.

Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med. 2007;357(5):470-6.

Manjunath CN, Srinivas P, Ravindranath KS, Dhanalakshmi C. Incidence and patterns of valvular heart disease in a tertiary care high-volume cardiac center: a single center experience. Indian Heart J. 2014; 66:320-6.

Malla R, Thapaliya S, Gurung P, Bogati A, Khadka S, Shrestha S, et al. Patterns of valvular involvement in rheumatic heart disease patients taking benzathine penicillin at Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Nepalese Heart J. 2016;13(2):25-7.

Lilyasari O, Prakoso R, Kurniawati Y, Roebiono PS, Rahajoe AU, Sakidjan I, et al. Clinical profile and management of rheumatic heart disease in children and young adults at a tertiary cardiac center in Indonesia. Front Surg. 2020;7:47.

Alkhalifa MS, Ibrahim SA, Osman SH. Pattern and severity of rheumatic valvular lesions in children in Khartoum, Sudan. East Mediterr Health J. 2008;14(5):1015-21.

Remenyi B, ElGuindy A, Smith SC Jr, Yacoub M, Holmes DR Jr. Valvular aspects of rheumatic heart disease. Lancet. 2016;387(10025):1335-46.

Saxena A, Desai A, Narvencar K, Ramakrishnan S, Thangjam RS, Kulkarni S, et al. Echocardiographic prevalence of rheumatic heart disease in Indian school children using World Heart Federation criteria- a multi site extension of RHEUMATIC study (the e-RHEUMATIC study). Int J Cardiol. 2017;249:438-42.

Baro L, Sharma N, Toor D, Chaliha MS, Kusre G, Baruah SM, et al. A hospital-based study of socioeconomic status and clinical spectrum of rheumatic heart disease patients of Assam, North-East India. Eur J Prev Cardiol. 2018;25(12):1303-6.

Zühlke L, Engel ME, Karthikeyan G, Rangarajan S, Mackie P, Cupido B, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J. 2015;36(18):1115-22a.

Chockalingam A, Gnanavelu G, Elangovan S, Chockalingam V. Clinical spectrum of chronic rheumatic heart disease in India. J Heart Valve Dis. 2003;12(5):577-81.

Faheem M, Hafizullah M, Gul A, Jan H, Khan M. Pattern of valvular lesions in rheumatic heart disease. J Postgrad Med Inst. 2011;21(2):99-103.

2006 Writing Committee Members, Bonow RO, Carabello BA, Chatterjee K, de Leon Jr AC, Faxon DP, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2008;118(15):e523-661.

Downloads

Published

2023-08-21

How to Cite

Alam, M. S., Rahman, M. A., Karim, M. F., Khatun, K., Abdul Hye, M., Munira, S., Raha, S. K., Biswas, S. K., & Jobayer, M. (2023). Spectrum of valvular lesions in newly diagnosed rheumatic heart disease. International Journal of Research in Medical Sciences, 11(9), 3239–3244. https://doi.org/10.18203/2320-6012.ijrms20232511

Issue

Section

Original Research Articles