Prevalence and determinants of pulmonary hypertension in rheumatic heart disease patients at university of Gondar comprehensive specialized hospital: a retrospective study from 2018 to 2023.

Abstract

Introduction: Most Rheumatic heart disease patients present with advanced disease and complications, pulmonary hypertension being one of the main complications. The presence of pulmonary hypertension is independently associated with increased pre-operative and perioperative morbidity and mortality in RHD patients. There are only few studies that showed the magnitude of pulmonary hypertension in RHD patients. This study was done to know the magnitude and predictors of PH in RHD patients so that early identification and intervention can be done for those at risk to develop PH.

Methods: An institution-based retrospective study was conducted by reviewing medical records of patients at adult echocardiographic unit from September, 2018 to September, 2023. Systolic PAP > 35mmHg using 2D echocardiography was used to diagnose pulmonary hypertension. Bi-variable logistic regression analysis followed by multivariable logistic regression analysis was done using SPSS statistics 25. P value < 0.05 and 95% CI was used to determine significant association.

Result: A total of 230 RHD patients were included during the study period between September 2018 and September 2023. Most patients were below the age of 35 years (68.3%) with median age of 28 years and interquartile range of 21 to 38 years. Among the study participants 72.2% were females and 67% of them were rural residents. PH prevalence among RHD patients was found to be 77.4% (95% CI: 71.4%, 82.6%). Most patients (51.3%) had severe PH (≥ 60mmHg), whereas Mild PH (36-44mmHg) was 7.4% and moderate PH (45-59mmHg) was 18.7%. PH was found to have significant association with severe MS (AOR = 5.31, 95%CI: 1.87, 15.06), moderate to severe MR (AOR = 2.68, 95% CI: 1.05, 6.84), NYHA functional class III and IV (AOR = 2.60, 95% CI: 1.01, 6.68) and Diuretics use (AOR = 4.43, 95% CI: 1.33, 14.70).

Conclusion: The prevalence of PH among rheumatic heart disease patients in this study was high. Moderate to severe MR, severe MS, NYHA class III and IV, and diuretics use were significantly associated with PH. Expanding surgical intervention to address this patients is needed to decrease PH prevalence and morbidity and mortality associated with it.