Application of the New 2023 World Heart Federation Criteria to Rheumatic Heart Disease in the Setting of First Episode of Acute Rheumatic Fever: Predictors for Resolution.

IF 1.4 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Jacqueline M Williamson, Gillian A Whalley, James Marangou, Peter S Morris, Zhiqiang Wang, Joshua R Francis, Bo Remenyi
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引用次数: 0

Abstract

Rheumatic heart disease (RHD) is a chronic complication of acute rhematic fever (ARF). Echocardiography is used to assess valve disease in ARF. Acute valvulitis in ARF may normalise once inflammation has subsided. In the Top End of the Northern Territory (NT), a diagnosis of RHD is regularly made in conjunction with ARF diagnosis. We aimed to determine if baseline echocardiogram features could predict resolution of RHD when diagnosed during ARF. This retrospective cohort study includes children and young Australians diagnosed concurrently with first ARF and RHD between January 2012 and December 2021. Echocardiograms were reclassified based on the 2023 World Heart Federation guidelines for diagnosis of RHD. Primary outcome was echocardiographic resolution of RHD. The NT register recorded 311 individuals with concurrent diagnoses of ARF and RHD with 165 eligible for inclusion. Median age was 10 years (IQR 8-13 years), and 51.5% were female. Early RHD was diagnosed in 64% (106/165) of cases. Median follow-up time was 34 months. Resolution of RHD occurred in 19% (32/165) and 97% (31/32) of those had Early RHD at diagnosis. Absence of mitral valve leaflet thickening, restriction, and excessive leaflet motion were all associated with RHD resolution with univariate analysis. Multivariate Cox proportional modelling found that Early RHD at baseline independently predicted RHD resolution with HR of 16.6 (95% CI 2.25-122.74, p = 0.006). No difference was found between Stage A or Stage B RHD, (p = 0.461). The morphological features of valve disease were not as important as the severity in predicting resolution of RHD.

新的2023年世界心脏联合会标准在急性风湿热首次发作时风湿性心脏病的应用:解决的预测因素
风湿性心脏病(RHD)是急性出血热(ARF)的慢性并发症。超声心动图用于评估ARF患者的瓣膜病变。一旦炎症消退,急性心瓣膜炎可能恢复正常。在北领地(NT)的高端,RHD的诊断通常与ARF诊断一起进行。我们的目的是确定基线超声心动图特征是否可以预测在ARF期间诊断的RHD的消退。这项回顾性队列研究包括2012年1月至2021年12月期间同时诊断为首次ARF和RHD的澳大利亚儿童和年轻人。超声心动图根据2023年世界心脏联合会RHD诊断指南重新分类。主要结果是超声心动图RHD的分辨率。NT登记记录了311例同时诊断为ARF和RHD的个体,其中165例符合纳入条件。中位年龄为10岁(IQR 8 ~ 13岁),51.5%为女性。早期RHD确诊率为64%(106/165)。中位随访时间为34个月。在诊断为早期RHD的患者中,有19%(32/165)和97%(31/32)的RHD得以缓解。单因素分析显示,没有二尖瓣小叶增厚、受限和过度的小叶运动都与RHD分辨率相关。多变量Cox比例模型发现,基线时早期RHD独立预测RHD分辨率的HR为16.6 (95% CI 2.25-122.74, p = 0.006)。A期和B期RHD无差异(p = 0.461)。在预测RHD的预后时,瓣膜病变的形态学特征不如其严重程度重要。
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来源期刊
Pediatric Cardiology
Pediatric Cardiology 医学-小儿科
CiteScore
3.30
自引率
6.20%
发文量
258
审稿时长
12 months
期刊介绍: The editor of Pediatric Cardiology welcomes original manuscripts concerning all aspects of heart disease in infants, children, and adolescents, including embryology and anatomy, physiology and pharmacology, biochemistry, pathology, genetics, radiology, clinical aspects, investigative cardiology, electrophysiology and echocardiography, and cardiac surgery. Articles which may include original articles, review articles, letters to the editor etc., must be written in English and must be submitted solely to Pediatric Cardiology.
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