ECHOCARDIOGRAPHIC PROFILE OF RHEUMATIC HEART DISEASE AT A TERTIARY CARDIAC CENTRE

Authors

  • Hamza Arslan Aurakzai
  • Shahid Hameed
  • Ahmad Shahbaz
  • Salman Gohar
  • Moqueet Qureshi
  • Habibullah Khan
  • Waqas Sami
  • Muhammad Azhar
  • Jawad Sajid Khan

Abstract

Background: Rheumatic Heart Disease (RHD) continues to be a major public health problem indeveloping countries like Pakistan. Objective of this cross sectional-analytical study was to analyzethe severity of valvular lesions on echocardiography in patients pre-diagnosed with RHD. Methods:The transthoracic echocardiographic records of RHD patients from 2004 to 2008 wereretrospectively reviewed for type and degree of valvular involvement according to AHA/ACCguidelines. Results: A total of 13,414 patients [7,219 Males (53.8%), 6,195 Females (46.2%)]ranging from 11 to 90 years with a mean age of 42.33±18.976 were studied. On echocardiography,7,500 (56%) had mitral regurgitation (8.8% severe MR), 6,449(48.2%) had tricuspid regurgitation(7.1% severe TR) and 5,550 (41.4%) had aortic regurgitation (4.8% severe AR). MS was detected in2,729 (20.3%) patients (15.3% severe MS), AS in 102 (0.8%) and TS in 31 (0.2%) patients. Mixedmitral valve disease was seen in 3,185 (23.7%), mixed aortic valve disease in 222 (1.7%) and mixedtricuspid valve disease in 47 (0.4%) patients. All three valves were involved in 2,826 (21.06%)patients, combination of mitral and aortic valves in 3,103 (23.13%), mitral and tricuspid in 3,784(28.2 %), and mitral only in 3,701 (27.59%) patients. There was some mitral valve abnormality in allpatients. Conclusion: Mitral valve was most commonly affected, while regurgitant lesions weremore common than stenotic lesions, and most severe in younger patients. All valvular lesions hadalmost an equal distribution among the sexes, except aortic regurgitation, which was more commonin females. Therefore, echocardiography should be done routinely for patients with RHD, focusingon younger population, to facilitate diagnosis and definitive treatment before complications set in.Keywords: Rheumatic heart disease, Echocardiography, Valvular heart disease

References

Krause MR. The influence of infection on the geography of heart

disease. Circulation 1979;60:972–6.

Rose A.G. Etiology of valvular heart disease. Curr Opin Cardiol

;11:98–113.

Aziz K. Incidence of heart disease in children at the National

institute of cardiovascular diseases. J Pak Med Assoc

;34:300–5.

Vijaykumar M, Narula J, Reddy KS, Kaplan EL. Incidence of

rheumatic fever and prevalence of rheumatic heart disease in

India. Intl. J Cardiol 1994;43:221–8.

Eisenberg MU. Rheumatic Heart Disease in the developing

world: prevalence, prevention and control. Eur Heart J

;14:122–8.

Akhtar N, Sadiq M, Chagani H, Hafeez A, Rizvi FH, Mehboob

M. Guidelines for prevention of Rheumatic fever and rheumatic

heart disease. Pak J Cardiol 2004;15:136–48.

Rizvi SF, Khan MA, Kundi A, Marsh DR, Samad A, Pasha O.

Status of Rheumatic heart disease in rural Pakistan. Heart

;90:394–9.

Syed SA, Raza M, Hashmi JA. Establishment of comprehensive

research and rehabilitation program for persons of various heart

diseases. Project, VRA Pak. Karachi: National Institute of

Cardiovascular Diseases. 1973: p.8–66.

Ilyas M, Peracha MA, Ahmed R, Khan N, Ali N, Janjua M.

Prevalence and pattern of rheumatic heart disease in the Frontier

Province of Pakistan. J Pak Med Assoc 1979;29:165–8.

Malik SM, Jaffery S, Ahmed S, Zubeda K. Prevalence of heart

disease in school children in Islamabad. Pak Heart J

;14(13):2.

Grover A, Vijayvergiya R, Thingam ST. Burden of

Rheumatic and Congenital Heart Disease in India: Lowest

Estimate Based on the 2001 Census. Indian Heart J

;54:104–7.

J Ayub Med Coll Abbottabad 2009;21(3)

http://www.ayubmed.edu.pk/JAMC/PAST/21-3/Aurakzai.pdf

Ahmed J, Mostafa Zaman M, Manzur Hassan MM. Prevalence

of rheumatic fever and rheumatic heart disease in rural

Bangladesh. Trop Doct 2005;35:160–1.

Danbauchi SS, Alhassan MA, Wammanda R. Spectrum of

rheumatic heart disease in Zaria,Northern Nigeria. Ann Afr Med

;3:17–21.

Narula J, Chandrasekhar Y, Rahimtoola S. Diagnosis of active

rheumatic carditis. The echoes of change.

Circulation.1999;100:1576–81.

Khan MH, Tasneem H, Khan SZ, Sharieff S. Echocardiogram:

Screening for valvular heart disease in an Out-patient clinic. Med

Today 2005;3(3):133–6.

Aronow WS, Kronzon I. Correlation of prevalence and severity

of aortic regurgitation detected by pulsed Doppler

echocardiography with the murmur of aortic regurgitation in

elderly patients in a long-term health care facility. Am J Cardiol

;63(suppl):128–9.

Aronow WS, Kronzon I. Correlation of prevalence and severity

of mitral regurgitation and mitral stenosis determined by Doppler

echocardiography with physical signs of mitral regurgitation and

mitral stenosis in 100 patients aged 62 to 100 years with mitral

anular calcium. Am J Cardiol 1987;60:1189–90.

Aronow WS, Kronzon I. Correlation of prevalence and severity

of valvular aortic stenosis determined by continuous-wave

Doppler echocardiography with physical signs of aortic stenosis

in patients aged 62 to 100 years with aortic systolic ejection

murmurs. Am J Cardiol 1987;60:399–401.

Grayburn PA, Smith MD, Handshoe R, Friedman BJ, DeMaria

AN. Detection of aortic insufficiency by standard

echocardiography, pulsed Doppler echocardiography, and

auscultation: a comparison of accuracies. Ann Intern Med

;104:599–605.

Meyers DG, McCall D, Sears TD, Olson TS, Felix GL. Duplex

pulsed Doppler echocardiography in mitral regurgitation. J Clin

Ultrasound 1986;14:117–21.

Vargas-Barron J, Bialostozky D, Attie F, Pop G, Keirns C, Gil

Moreno M et al. Differential diagnosis of various causes of

systolic-diastolic murmurs using pulsed Doppler

echocardiography. Am Heart J 1984;108:1507–13.

Saal AK, Gross BW, Franklin DW, Pearlman AS. Noninvasive

detection of aortic insufficiency in patients with mitral stenosis by

pulsed Doppler echocardiography. J Am Coll Cardiol

;5:176–81.

Cheitlin MD, Alpert JS, Armstrong WF, Aurigemma GP, Beller

GA, Bierman FZ, et al. ACC/AHA Guidelines for the Clinical

Application of Echocardiography. A report of the American

College of Cardiology/ American Heart Association Task Force

on the Practice Guidelines (Committee on Clinical Application of

Echocardiography). Developed in collaboration with the

American Society of Echocardiography. Circulation

;95:1686–744.

Reddy A, Jatana SK, Nair MNG. Clinical evaluation versus

echocardiography in the assessment of rheumatic heart disease.

MJAFI 2004;60:255–8.

Marcus RH, Sareli P, Pocock WA, Barlow JB. The spectrum of

severe rheumatic mitral valve disease in a developing country.

Ann Intern Med 1994;120:177–83.

Blaustein AS, Ramanathan A. Tricuspid valve disease. Cardiol

Clin 1998;16(3):551–72.

Tandon R. Acute rheumatic fever and rheumatic heart disease.

In: Ghai OP (ed) Essential Pediatrics, 5th ed. New Delhi:

Interprint; 2000: p.274–85.

Thakur JS, Negi PC, Ahluwalia SK, Sharma R. Integrated

community-based screening for cardiovascular diseases of

childhood. World Health Forum 1997;18:24–7.

Agarwal AK, Yunus M, Ahmad J, Khan A. Rheumatic heart

disease in India. J R Soc Health 1995;115:303–4, 309.

al-Sekait MA, al-Sweliem AA, Tahir M. Rheumatic heart disease

in schoolchildren in western district, Saudi Arabia. J R Soc

Health 1990;110:15–16, 19.

Ibrahim-Khalil S, Elhag M, Ali E, Mahgoub F, Hakiem S, Omer

N, et al. An epidemiological survey of rheumatic fever and

rheumatic heart disease in Sahafa Town, Sudan. J Epidemiol

Community Health 1992;46:477–9.

Oli K, Tekle-Haimanot R, Forsgren L, Ekstedt J. Rheumatic

heart disease prevalence among schoolchildren of an Ethiopian

rural town. Cardiology 1992;80:152–5.

Reddy CRRM, Jagabandhu N. Rheumatic heart disease in

Kurnool. Indian Heart J 1968;149–56.

Mason T, Fisher M, Kujala G. Acute Rheumatic fever in West

Virginia-not just a disease of children. Arch Intern Med

;151:133–6.

Published

2009-09-01

Most read articles by the same author(s)

1 2 3 > >>