da Silva Telêmaco Luis, Pazin-Filho Antonio, Romano Minna M D, Ferriani Virgínia P L, Marin-Neto José A, Maciel Benedito C, Schmidt André
Internal Medicine Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
Pediatrics Department, Medical School of Ribeirão Preto, University of São Paulo, São Paulo, Brazil.
PLoS One. 2021 Nov 17;16(11):e0259737. doi: 10.1371/journal.pone.0259737. eCollection 2021.
Rheumatic heart disease (RHD) complicating acute rheumatic fever (ARF) remains an important health problem in developing countries. No definitive diagnostic test for ARF exists and the role of Doppler echocardiography (DEC) for long-term prognostic evaluation following ARF is not well established.
To investigate the prognostic value of DEC in patients with ARF as a predictor of chronic valve dysfunction.
Prospectively enrolled patients with clinical ARF had a DEC performed soon after diagnosis and repeated at 1, 3, 6 and 12 months and thereafter at every 1-2 years. We defined chronic valve dysfunction by ≥ 3 of the following: increased valve thickening, commissure fusion, subvalvular thickening, reduced leaflet mobility, non-trivial mitral and/or aortic regurgitation. We performed univariate analysis and developed multivariate logistic regression models to identify variables that may influence evolution to RHD. p <0.05 was considered significant.
We evaluated 70(57% men) patients, 10.8±5.6 years-old during the ARF episode and followed for 95±26 months. Chronic valve dysfunction was identified in 36(51.4%) which fulfilled criteria for RHD and 10(27.8%) of them died or underwent valve surgery. Univariate analysis showed that mitral valve thickening and presence of mitral regurgitation at baseline DEC, were associated with RHD(p<0.01). Multivariate logistic regression showed that only mitral valve thickness either as a continuous (Odds-Ratio:5.8;95%CI:1.7-19.7) or as a categorical variable (Odds-Ratio:4.04;95%CI:1.06-15.3) was an independent predictor of chronic valve dysfunction.
Mitral leaflets thickening documented at the time of diagnosis of ARF is a consistent prognostic marker for the subsequent evolution to RHD.
风湿性心脏病（RHD）合并急性风湿热（ARF）在发展中国家仍然是一个重要的健康问题。目前尚无针对ARF的确切诊断测试，且多普勒超声心动图（DEC）在ARF后长期预后评估中的作用尚未明确确立。
探讨DEC对ARF患者作为慢性瓣膜功能障碍预测指标的预后价值。
前瞻性纳入临床诊断为ARF的患者，诊断后不久进行DEC检查，并在1、3、6和12个月时重复检查，此后每1 - 2年复查一次。我们将慢性瓣膜功能障碍定义为符合以下至少3项：瓣膜增厚增加、瓣叶融合、瓣下增厚、瓣叶活动度降低、中重度二尖瓣和/或主动脉瓣反流。我们进行了单因素分析并建立了多因素逻辑回归模型，以确定可能影响发展为RHD的变量。p<0.05被认为具有统计学意义。
我们评估了70例（57%为男性）患者，ARF发作时年龄为10.8±5.6岁，随访95±26个月。36例（51.4%）出现慢性瓣膜功能障碍，符合RHD标准，其中10例（27.8%）死亡或接受瓣膜手术。单因素分析显示，基线DEC时二尖瓣增厚和二尖瓣反流与RHD相关（p<0.01）。多因素逻辑回归显示，仅二尖瓣厚度作为连续变量（比值比：5.8；95%置信区间：1.7 - 19.7）或分类变量（比值比：4.04；95%置信区间：1.06 - 15.3）是慢性瓣膜功能障碍的独立预测指标。
ARF诊断时记录的二尖瓣叶增厚是随后发展为RHD的一致预后标志物。
