Intramuscular penicillin prophylaxis and valve progression in adults with mild rheumatic heart disease: a propensity score-matched cohort study.

IF 4 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Acta cardiologica Pub Date : 2026-08-01 DOI:10.1080/00015385.2026.2704733

Ayse Huseyinoglu Aydin, Fatih Aydın

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引用次数: 0

Abstract

Background: Evidence supporting intramuscular penicillin prophylaxis in rheumatic heart disease (RHD) is largely derived from paediatric populations, and its role in adults with mild disease remains unclear. We aimed to evaluate its impact on valve progression in adults with early-stage RHD.

Methods: This retrospective cohort study included 312 adults with World Heart Federation (WHF) Stage A or B RHD. Patients were stratified according to receipt of intramuscular penicillin prophylaxis. The primary outcome was a composite of valve progression or new valve disease. Baseline imbalances were assessed using standardised mean differences (SMD), and propensity score matching (1:1) was applied. Outcomes were compared using relative risks (RR), and time-to-event analysis was performed using Kaplan-Meier estimates.

Results: Over a follow-up period of 8-12 years (median 10.1 years), event rates were low. Valve progression occurred in 2.0% of patients without prophylaxis and in 1.7% of patients with prophylaxis (RR 0.84; 95% CI 0.16-4.54; p = 1.000). New valve disease developed in 2.0% and 2.6% of patients, respectively (RR 1.27; 95% CI 0.29-5.56; p = 0.714). The composite outcome occurred in 4.1% of the no-prophylaxis group and 4.3% of the prophylaxis group (RR 1.06; 95% CI 0.35-3.15; p = 1.000). After propensity score matching (n = 116 per group), baseline characteristics were well balanced across all covariates, and prophylaxis was not associated with the composite outcome (OR 0.70; 95% CI 0.22-2.28; p = 0.555).

Conclusion: In adults with mild RHD, intramuscular penicillin prophylaxis was not associated with reduced valve progression or new valve disease. Careful clinical and echocardiographic follow-up may be a reasonable strategy in selected patients.

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成人轻度风湿性心脏病患者肌肉注射青霉素预防和瓣膜进展：一项倾向评分匹配的队列研究

背景：支持肌肉注射青霉素预防风湿性心脏病（RHD）的证据主要来自儿科人群，其在轻度疾病成人中的作用尚不清楚。我们的目的是评估其对成人早期RHD患者瓣膜进展的影响。方法：这项回顾性队列研究包括312名患有世界心脏联合会（WHF） A期或B期RHD的成年人。根据肌肉注射青霉素预防治疗的情况对患者进行分层。主要结局是瓣膜进展或新瓣膜疾病的综合结果。使用标准化平均差异（SMD）评估基线失衡，并采用倾向评分匹配（1:1）。使用相对风险（RR）比较结果，使用Kaplan-Meier估计进行事件时间分析。结果：随访8-12年（中位10.1年），事件发生率较低。未预防的患者中有2.0%发生瓣膜进展，而预防的患者中有1.7%发生瓣膜进展（RR 0.84; 95% CI 0.16-4.54; p = 1.000）。分别有2.0%和2.6%的患者发生新的瓣膜疾病（RR 1.27; 95% CI 0.29-5.56; p = 0.714）。无预防组和预防组的复合结局发生率分别为4.1%和4.3% （RR 1.06; 95% CI 0.35-3.15; p = 1.000）。倾向评分匹配后（每组n = 116），基线特征在所有协变量之间得到很好的平衡，预防与综合结果无关（OR 0.70; 95% CI 0.22-2.28; p = 0.555）。结论：在成人轻度RHD患者中，肌肉注射青霉素预防与瓣膜进展减少或新的瓣膜疾病无关。仔细的临床和超声心动图随访可能是一个合理的策略，在选定的患者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Acta cardiologica 医学-心血管系统

CiteScore

2.50

自引率

12.50%

发文量

115

审稿时长

2 months

期刊介绍： Acta Cardiologica is an international journal. It publishes bi-monthly original, peer-reviewed articles on all aspects of cardiovascular disease including observational studies, clinical trials, experimental investigations with clear clinical relevance and tutorials.