<p>Clinical, Echocardiographic Characteristics and Management Practices in Patients with Rheumatic Valvular Heart Disease</p>

Abstract

Background: Rheumatic heart disease (RHD) is the long-term consequence of acute rheumatic fever (ARF), continues unabated among middle-income and low-income countries. Thus, this study aimed to assess clinical characteristics, echocardiographic characteristics, and management practice of RHD patients. Methods: Hospital-based prospective cross-sectional study was used. The data were collected from medical records of consecutive patients admitted to medical wards during the study period. The data were cleaned and analyzed using SPSS version 20. Descriptive statistics were used to describe the data. Chi-square was used to compare proportions between categorical variables. Results: Forty-seven patients with a median (IQR) age of 28.0 (17.0-40.0) years were included. Pan systolic murmur was reported in 91.50% of patients. Forty-two (89.4%) of patients were presented with congestive heart failure and 23 (48.9%) with atrial fibrillation. Mitral valve leaflet thickening and calcification with restriction of motion were reported in 91.5% of patients. Mitral regurgitation (MR) (87.2%) and stenosis (MS) (85.1%) were the most common valvular lesions. The combinations of three (MR+MS+TR) 14 (29.8%) and four (MR+MS+TR+AR) 13 (27.7%) valve diseases were most commonly reported. Diuretics (95.7%), anticoagulants (38.3%), digoxin (36.2%), and beta-blockers (34.0%) were among the commonly prescribed medications. Conclusion: Rheumatic heart disease affected younger adults. Pansystolic murmur was reported in nearly all patients. Congestive heart failure and atrial fibrillation were common clinical presentations. Morphologic changes in mitral valve and pathologic mitral regurgitation were the most common echocardiographic reports. Cardiovascular medications were commonly utilized for symptomatic management of complications Therefore, echocardiography should be done routinely for patients with RHD, focusing on younger adults, to facilitate diagnosis and treatment before complications develop.

Etiologies and Patterns of Valvular Heart Disease Among Cardiac Patients at the Cardiac Center of Ethiopia During February 2000 to April 2022

“… 26 Another prospective cross-sectional study conducted at Jimma Medical Center, a tertiary hospital in Jimma City, Southwest Ethiopia, also reported that MR (87.2%) was the most common valvular lesion. 27 A similar study done by Desta et al also reported that 136 (97.1%) of patients had mitral regurgitation, which was significantly higher than our study findings. 28 This variation could be due to differences in study design and sample size.…”

Clinical Profile of Patients with Atrial Fibrillation According to EHRA (Evaluated Heart Valves, Rheumatic or Artificial) Categorization in A Middle-Income Country

“…Nationwide cohort study with a large sample of patients with valvular heart disease and AF, but with 90% of patients with EHRA type 2, demonstrated a rate of 14.6% and 18.6% of thromboembolism in patients with EHRA type 1 and EHRA type 2, respectively [17]. A study from the same group showed that the rate of previous thromboembolism ranged from 10.0% to 14.6% between patients in both groups [18]. The higher rate of thromboembolism in our study can be explained by the higher proportion of patients with moderate to severe mitral stenosis in group 1, which was 89.5%, compared to the rate of 29.2% in the study mentioned above.…”

“…Thus, the greater proportion of women in group 1 in this study is in line with the literature as well as age. Rheumatic valvular heart disease affects more young people, unlike the degenerative etiology that affects older patients [7]- [10].…”

Investigation into the early modification of left ventricular mass following mitral valve replacement and the development of a nomogram prediction model

“…The LVM of patients with rheumatic heart disease is lighter than that of patients with degenerative valvular disease, and the enddiastolic volume and end-systolic volume of left ventricle in rheumatic heart disease are smaller than those in degenerative valvular disease. This may be due to the fact that mitral valve damage caused by rheumatic heart disease is not only regurgitation, but also narrowing caused by coiled fusion of the lobes [22][23][24]. However, degenerative valvular disease is mainly caused by left ventricular centrifugal dilation due to enlarged valve ring, poor valve quality, and myxopathic valve insu ciency [25,26].…”