Presence Of Rheumatic Heart Disease Research Articles

Insights into Angiographic Recanalization of Large Arterial Occlusion: Institutional Experience with Mechanical Thrombectomy for Acute Ischemic Stroke.

Stroke is a leading cause of morbidity and mortality in humans. Most strokes are ischemic in nature and early recanalization of occluded vessels determines good outcomes. Recanalization of occluded vessels depends on many angiographic and demographic features. These factors need to be identified for better patient overall outcomes. Better preoperative knowledge of factors can help in customizing our treatment approach and explaining the prognosis to the guardians of the patients. We aim to share our institutional experience with mechanical thrombectomy (MT) for stroke and studied factors that affect an angiographic recanalization of vessels . A retrospective single-center study was conducted involving 104 patients who underwent MT at our institution between January 2016 and December 2019. Patient demographics, baseline characteristics, pre- and postprocedural imaging findings, and other clinical data were meticulously reviewed. We divided patients into successful recanalization (modified thrombolysis in cerebral ischemia [mTICI] 2b or 3) and unsuccessful recanalization (mTICI 2a or 1) groups and various factors were analyzed to evaluate their impact on recanalization rates. In the univariate analysis, a significant association was observed between successful recanalization and several factors: the absence of rheumatic heart disease (RHD) as a risk factor ( p = 0.035), the presence of a hyperdense vessel sign ( p = 0.003), and the use of treatment methods including aspiration ( p = 0.031), stent retriever ( p = 0.001), and Solumbra ( p = 0.019). However, in the multivariate analysis, none of these factors exhibited statistical significance. The presence of RHD is a risk factor associated with poor angiographic recanalization in all three MT treatment modalities. Based on the above variables we can guide the patients/relatives prior to MT procedure for their better outcome and risk-benefit ratio.

In-hospital outcomes of patients with myelodysplastic syndromes and rheumatic heart disease: A National Inpatient Sample study (2018-2020).

e18525 Background: Autoimmune conditions are relatively uncommon in patients with Myelodysplastic syndromes (MDS), with only a small proportion of patients affected. Among these autoimmune conditions, rheumatic heart disease (RHD) is the most commonly associated with MDS. Very few cases have been reported in literature that show the impact of RHD on patients diagnosed with MDS. In this study, we aimed to investigate the impact of RHD on the patients with myelodysplastic syndrome who were admitted in hospitals from 2018-2020. Methods: We utilized National Inpatient Sample (NIS) 2018-2020 to identify hospitalizations of patients with Myelodysplastic syndromes with a secondary diagnosis of Rheumatic heart disease. The primary outcomes examined were In-patient mortality and average length of stay, All the patients with MDS were divided into two cohorts based on the presence of rheumatic heart disease. Multivariable regression analyses were conducted, taking into account demographics, hospital-level characteristics, and pertinent comorbidities as adjusting factors. Results: Using the NIS dataset from 2018 to 2020, we identified 222,364 patients admitted with MDS during this period. Among them, 4.57% (10,162 patients) also had a diagnosis of rheumatic heart disease (RHD). The average age of patients with MDS and RHD was 80 years. Among these patients, 50.1% were male and 49.9% were female. The mortality rate among patients admitted with MDS and coexisting RHD was 7.7%. Multivariate regression analysis indicated that the presence of RHD increased the likelihood of mortality with an odds ratio (OR) of 1.2 (95% confidence interval [CI]: 1.0-1.4, p-value <0.05). Additionally, RHD was associated with a higher incidence of arrhythmias (OR: 2.9) and congestive heart failure (OR: 5.0) among MDS patients. The total hospital charges were more in patients with RHD than those without RHD ($80108 vs $82843). However, there was no significant difference in the length of stay (LOS) between patients with MDS alone and those with MDS and RHD. Conclusions: Rheumatic heart disease (RHD) cases in patients with MDS are rare in clinical practice, leading to uncertainty regarding the effects of RHD on admitted MDS patients. Our study sheds light on the influence of RHD on mortality and other outcomes in this patient population. The efficacy of timely RHD treatment in reducing mortality and improving outcomes among hospitalized MDS patients remains to be verified in future investigations. [Table: see text]

Rheumatic Heart Disease In School Going Children: A Study From Lumbini Province, Nepal

INTRODUCTION Rheumatic Heart Disease is declining from developed countries but still is important cause of morbidity and mortality in under- developed and developing countries. MATERIAL AND METHODS It was a prospective observational study conducted at Lumbini Province Nepal. Seven thousand six hundred and fourty school going children were evaluated to look for presence of Rheumatic Heart Disease. RESULTS Out of total 7640 school going children 56.6% were male and 43.4% were female. Majority (74%) of children evaluated belonged to Government school. Most of the children (54.7%) were of more than 10 years of age. Clinically murmur was present in 8.9%. RHD was found in total 14 children with prevalence of 1.83 per thousand children. RHD was more common in female (64%) than male (36%). Most common valve involvement was Mitral valve and most common lesion was Mitral Stenosis. CONCLUSION RHD is still of major health concern among school going children in Lumbini Province Nepal. Strategies to reduce its occurrence in the community is important to reduce its complications.

Clinical predictive factors of coronary stenosis in patients with high‑risk valvular heart disease who received diagnostic coronary angiography prior to cardiac valve surgery.

Valvular heart disease (VHD) may lead to morbidities and mortality due to heart failure or sudden death. Concomitant coronary artery disease (CAD) is a crucial condition that needs to be explored in patients with VHD prior to cardiac valve surgery as it may increase morbidity and mortality. Patient age >40 years and mitral regurgitation are key risk factors for CAD in patients with VHD. The present study aimed to identify clinical risk factors for coronary stenosis in patients with high-risk VHD. The retrospective cohort study recruited patients aged >40 years who received cardiac valve surgery and coronary angiogram prior to cardiac valve surgery. Clinical factors predictive of coronary stenosis were computed by logistic regression analysis. There were 533 patients; 114 patients (21.38%) had coronary stenosis. Four factors were positively associated with coronary stenosis including age, male sex, mitral regurgitation and hypertension, while two factors were negatively associated with coronary stenosis, namely estimated glomerular filtration rate and rheumatic heart disease. Hypertension had the highest adjusted odds ratio at 2.596, while rheumatic heart disease had the lowest adjusted odds ratio at 0.428. Patient age >55 years showed a sensitivity and specificity of coronary stenosis of 80.70 and 37.47%, respectively. Clinical factors predictive of coronary stenosis in patients with high-risk VHD were age >55 years, male sex, mitral regurgitation and hypertension, while a high estimated glomerular filtration rate and presence of rheumatic heart disease were protective factors.

Abstract 15393: Low Risk of Rheumatic Heart Disease Among Children Found to Have an Alternate Diagnosis to Acute Rheumatic Fever in a High Risk Setting

Introduction: In 2015, the American Heart Association revised the Jones Criteria, the gold standard for diagnosis of acute rheumatic fever (ARF). This revision included changes to increase the sensitivity for ARF in high-risk settings. The objective of this study was to determine if there were children who were found to be ARF-negative by strict application of these criteria in a high risk setting but found to have rheumatic heart disease (RHD) on follow-up evaluation. Methods: Between 2017 and 2020, we conducted an epidemiological study to determine the incidence of ARF in Uganda. Children and adolescents, 3-17 years, presenting with clinical concern for ARF (fever and joint pain, suspicion of carditis, or suspicion of chorea) were enrolled and evaluated using the Jones Criteria. Children ultimately found to have a laboratory-confirmed alternate diagnosis and those who did not meet ARF criteria but had an unknown final diagnosis, were asked to participate in a longitudinal echocardiographic follow-up study to monitor for development of RHD. Presence of RHD was considered a false negative test and used to calculate the false negative error of not receiving a diagnosis of ARF. Results: There were 351 children determined to have an alternate diagnosis during the study period; 180 with a laboratory confirmed final diagnosis (127 malaria, 20 non-rheumatic cardiac disease, 15 influenza, 18 other) and 171 with an unknown final diagnosis. Of these, 220 (62.7%) had at least one follow-up visit (median 366 days, range 10-1054). One child (1/220, <1%) developed echocardiographic evidence of borderline RHD during the follow-up period. Diagnostic overlap (met Jones Criteria but found to have a laboratory confirmed alternate diagnosis) was seen in 18% (33/180) of those with laboratory confirmed alternate diagnosis. Of these, 21 of 33 attended at least one follow-up (median 340 days, range 10-1054), and none showed echocardiographic evidence of RHD. Conclusions: Application of the 2015 Jones Criteria showed an exceptionally low rate of subsequent RHD, even in cases of diagnostic overlap. Clinicians working in ARF-endemic settings can have high confidence that children who do not meet criteria for ARF have a low risk of false negative diagnosis and short-term risk of RHD.

Meta-analysis of the relationship between single nucleotide polymorphism of IL-10-1082G/A and rheumatic heart disease.

BackgroundThe results showed that there was a certain correlation between the single nucleotide polymorphism of IL-10-1082G/A and rheumatic heart disease, but there was no systematic study to verify this conclusion.AimsSystematic review of the association between single nucleotide polymorphism of IL-10-1082G/A locus and rheumatic heart disease.Materials and MethodsComputer retrieval PubMed, EMbase, Cochrane Library, CBM, CNKI, VIP and Data WanFang, the retrieval time limit from inception to June 2017. A case control study of single nucleotide polymorphisms and rheumatic heart disease in patients with rheumatic heart disease in the IL-10-1082G/A was collected. Two researchers independently screened the literature, extracted data and evaluated the risk of bias in the study, and using RevMan5.3 software for data analysis.ResultsA total of 3 case control studies were included, including 318 patients with rheumatic heart disease and 502 controls. Meta-analysis showed that there was no correlation between IL-10-1082G/A gene polymorphism and rheumatic heart disease [AA+AG VS GG: OR = 0.62, 95% CI (0.28, 1.39), P = 0.25; AA VS AG+GG: OR = 0.73, 95% CI (0.54, 1.00), P = 0.05; AA VS GG: OR = 0.70, 95% CI(0.47, 1.05), P = 0.08; AG VS GG: OR = 0.65, 95% CI (0.22, 1.92), P = 0.43; A VS G: OR = 0.87, 95% CI (0.71, 1.06), P = 0.17].ConclusionsWhen AA is a recessive gene, the single nucleotide polymorphism of IL-10-1082G/A is associated with the presence of rheumatic heart disease. Due to the limitations of the quantity and quality of the included literatures, the further research results were still needed.

The benefits and harms of rheumatic heart disease screening from the perspective of the screened population

BackgroundA reduction in the burden of rheumatic heart disease (RHD) may be possible by identifying the condition while the patient is still asymptomatic. Currently, there is much debate about whether it is appropriate to screen for the presence of rheumatic heart disease (RHD) in a symptomless population. The purpose of this study was to identify self-reported benefits and harms from the perspective of screening participants and their families. MethodsIn order to describe participant experiences and changes in behaviour post-screening, we interviewed a sample of parents/caregivers of children who were screened for the presence of RHD between 2007 and 2012 (n=276). A total of n=91 parents/caregivers of children diagnosed with either definite, probable or possible/borderline RHD (‘abnormal’ cases) were interviewed either by telephone or in-person, along with at least two matched controls (n=185 ‘normal’ controls). ResultsWe observed evidence of long-standing anxiety and changes in physical activity among those who received an ‘abnormal’ screening result. The screening event appeared to have minimal impact on those who received a ‘normal’ result. There was some evidence of improved sore throat advice-seeking following the screening event, particularly among case respondents; however this group showed poorer understanding of the screening test compared to control respondents. ConclusionsAmong other points of discussion, this study brings to light issues regarding a) diminished physical activity habits among those receiving an abnormal result; b) levels of worry (and reassurance) among the screened population, depending on screening outcome; and c) general issues regarding the health literacy of the screened population.

INFECTIVE ENDOCARDITIS IN A RHEUMATOLOGIST'S PRACTICE

Objective: to analyze «rheumatic» symptoms in patients with infective endocarditis (IE) and to investigate the specific features of the disease and hemodynamics in patients with prior rheumatic valvular disease Subjects and methods. The study included 184 patients with documented IE. The rate of “rheumatic” manifestations, such as joint, muscle, and skin lesions, visceral disorders, and laboratory changes, was estimated. Central hemodynamic parameters were studied in patients with IE in the presence of rheumatic heart disease. Results. Locomotor apparatus lesion was noted in 44.8% of the patients with IE, cutaneous hemorrhagic vasculitis in 18%, pericarditis in 10%, pleurisy in 19%, glomerulonephritis in 60%, leukopenia in 9%, thrombocytopenia in 32%, elevated C-reactive protein levels in 92%, circulating immune complexes in 72%. Glomerulonephritis and hemorrhagic vasculitis more frequently develop in injection drug users (p < 0.0001). Rheumatic heart disease was pre-ceded by IE in 24 patients (13% among the all patients and 27% among those with secondary IE). In the patients with secondary IE evolving in the presence of prior rheumatic heart disease, pulmonary artery systolic pressure (PASP) and cardiac arrhythmia rates were significantly higher than those in primary IE (62.5 and 53 mm Hg; p < 0.05; 62 and 32%; p < 0.025). Conclusion. The «rheumatic» manifestations were common in patients with IE and require their differential diagnosis with rheumatic diseases. Their degree correlates with systemic in-flammatory disease activity. In the patients with IE and prior rheumatic heart involvement, PASP and the frequency of arrhythmias are higher than in those with primary IE.

Prediction of Left Atrial Fibrosis With Speckle Tracking Echocardiography in Mitral Valve Disease: A Comparative Study With Histopathology

Background and ObjectivesLeft atrial (LA) fibrosis is a main determinant of LA remodeling and development of atrial fibrillation. However, non-invasive prediction of LA fibrosis is challenging. We investigated whether preoperative LA strain as measured by speckle tracking echocardiography could predict the degree of LA fibrosis and LA reverse remodeling after mitral valve (MV) surgery.Subjects and MethodsSpeckle tracking echocardiography and LA volume measurements were performed in 50 patients one day before MV surgery. LA tissues were obtained during the surgery, and the degrees of their interstitial fibroses were measured. LA volume measurements were repeated within 30 days after surgery (n=50) and 1-year later (n=39).ResultsLeft atrial global strain was significantly correlated with the degree of LA fibrosis (r=-0.55, p<0.001), and its correlation was independent of age, underlying rhythm, presence of rheumatic heart disease and type of predominant MV disease (B=-1.37, 95% confidence interval -2.32 - -0.41, p=0.006). The degree of LA fibrosis was significantly correlated with early (r=-0.337, p=0.017) and 1-year (r=-0.477, p=0.002) percent LA volume reduction after MV surgery, but LA global strain was not significant.ConclusionLeft atrial strain as measured by speckle tracking echocardiography might be helpful for predicting the degree of LA fibrosis in patients with MV disease.

Co-existence of quadricuspid aortic and pulmonary valves in an adolescent with rheumatic heart disease

SummaryWe describe a male adolescent with co-existence of quadricuspid aortic and pulmonary valves and rheumatic heart disease. As far as we know, the presence of quadricuspid aortic and pulmonary valves in the same patient has not previously been described. Furthermore, the presence of rheumatic heart disease in this case makes it a true rarity.

Clinical features of recurrent embolization in acute cardioembolic stroke.

Recurrent embolization is a serious problem in acute cardioembolic stroke. However, the clinical features and predisposing factors of recurrent embolization have not been fully elucidated. Subjects were 227 consecutive patients (128 men and 99 women, aged 68.6 +/- 13.2 years) with acute cardioembolic stroke who did not receive anticoagulant therapy during the first 14 days after stroke onset. We assigned the subjects to two groups according to the occurrence or nonoccurrence of recurrent attacks within 14 days of the stroke onset. We assessed their clinical features, coagulation study results, and underlying heart disease. Recurrent brain or systemic embolization during the first 14 days after onset was noted in 46 patients (20.3%, group A) but not in the other 181 (group B). Recurrent embolization was more frequently noted at an early phase than at a late phase during the initial 14 days. Mortality was higher in group A (19.6%) than in group B (8.8%). The mean plasma level of antithrombin III (77.8 +/- 19.5%) at admission in group A patients was significantly lower than that in group B patients (87.9 +/- 15.5%). After admission, hematocrit decreased in group B patients but slightly increased in group A patients, in whom diuretics were more commonly used. Rheumatic heart disease and prosthetic valves, in addition to the presence of intracardiac thrombi, were seen more commonly in group A patients, whereas atrial fibrillation without organic heart disease and myocardial infarction were more frequent in group B patients. Low plasma levels of antithrombin III, dehydration, the use of diuretics, and the presence of rheumatic heart disease, prosthetic valves, and intracardiac thrombi seem to be predisposing factors for recurrent embolization. Immediate anticoagulation may be considered in acute cardioembolic stroke patients if such predisposing factors are demonstrated.

Relationship of atrial fibrillatory wave amplitude to left atrial size and etiology of heart disease: An old generalization re-examined

It is commonly stated that coarse f waves in atrial fibrillation suggest the presence of rheumatic heart disease and large left atrial size, whereas fine f waves indicate non-rheumatic disease and small left atrial size. Using echocardiography as a more reliable indicator of left atrial size, 37 consecutive patients with chronic atrial fibrillation were evaluated. The correlation coefficients between left atrial size and maximum f wave amplitude was −0.12 and −0.07, using average f wave amplitude. Only 53 per cent (9 of 17) of patients with rheumatic heart disease had f wave > 1 mm. and 56 per cent (10 of 18) of patients with f wave size ≤ 1 mm. had non-rheumatic disease. This study refutes the contention that the f wave amplitude in atrial fibrillation is correlated with either left atrial size or etiology of heart disease. It is possible that an intra-atrial conduction defect is responsible for coarse f wave morphology.

Combined Acute Rheumatic Fever and Congenitally Bicuspid Aortic Valve: A Hitherto Unconfirmed Combination

An 18-year-old man is described in whom rheumatic heart disease, as evidenced by the presence of classic Aschoff bodies, occurred in combination with a congenitally bicuspid (purely incompetent) aortic valve. To our knowledge, this is the first report documenting the presence of rheumatic heart disease and congenitally bicuspid aortic valve in the same patient.

Masked rheumatic myocarditis in an elderly male.

AbstractA case is described in which active rheumatic myocarditis was found at autopsy in a 77‐year‐old man. Although he had been admitted many times to the V.A. Hospital during a period of about fourteen years, at no time did the history, physical examination, roentgenograms, electrocardiograms and laboratory determinations arouse any suspicion of the presence of rheumatic heart disease.

The first ten years of rheumatic infection in childhood

The results of a follow-up study of 547 children who were observed for a ten-year period following the onset of rheumatic infection have been presented. At termination of the initial attack, 59.2 per cent showed evidence of the presence of rheumatic heart disease. Of 219 individuals with no clinical evidence of heart disease at termination of their first attack, 76.7 per cent still showed no evidence of heart disease ten years after onset. Only 5 per cent of this group with potential heart disease at onset had died of rheumatic infection or bacterial endocarditis. Of 318 individuals with rheumatic heart disease at onset, thirty (9.4 per cent) showed disappearance of signs of cardiac inyoly ment. Of this group with rheumatic heart disease at onset, 42.1 per cent had died of rheumatic infection or bacterial endocarditis. The most significant prognostic factor, in so far as the initial illness is concerned, is related to the presence or absence of obvious signs of cardiac damage. Chorea at onset is relatively benign because it is less likely to be associated with carditis than is polyarthritis or other types or rheumatic infection. Ten years after onset, 60.3 per cent of these rheumatic individuals were leading a normal existence with little or no limitation of activity. The majority of individuals presenting no functional incapacity, however, were those who showed no clinical evidence of heart disease at the termination of the initial attack. Twenty-four and four-tenths per cent of the total group had died of rheumatic infection, the predominant number of deaths occurring among those in whom a diagnosis of rheumatic heart disease had been made following recovery from the first attack. Death had occurred in only 5 per cent of the group in whom an original diagnosis of potential heart disease had been made, in comparison with a death rate of 42 per cent among those diagnosed as having rheumatic heart disease at onset.

RHEUMATIC INFECTION IN CHILDHOOD: FIFTEEN TO TWENTY YEAR FOLLOW-UP

IN A PREVIOUS paper 1 an analysis was presented of the outcome of rheumatic infection ten years after onset in a group of patients whose initial illness had occurred during the period 1923 to 1937, inclusive. The original group comprised 588 children, of whom 537 (91.3 per cent) had been located at the end of the ten year period. At the termination of the initial attack, 60 per cent had shown evidence of the presence of rheumatic heart disease. Of these 318 children with clinical evidence of heart disease at onset, signs of cardiac involvement had disappeared in 9 per cent. Forty-two per cent of those with early signs of rheumatic heart disease had died of rheumatic infection or bacterial endocarditis. Of 219 patients without clinical evidence of heart disease at the termination of their first attack, 77 per cent still did not show evidence of heart disease ten years