School of Medicine, Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, P.O.BOX 65001, Tanzania.
Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, Dar Es Salaam, Tanzania.
BMC Cardiovasc Disord. 2023 Aug 17;23(1):403. doi: 10.1186/s12872-023-03427-0.
Arrhythmia is a known complication of rheumatic heart disease (RHD). It is critical to recognize arrhythmias early on so that prompt preventative actions and vigilant monitoring may be considered while treating these patients.
This study aimed at determining the prevalence, clinical characteristics and echocardiographic parameters of arrhythmias among RHD patients attending Jakaya Kikwete Cardiac Institute (JKCI).
Hospital-based cross-sectional study was conducted among 390 patients with an echocardiographic diagnosis of RHD aged 18years and above attending JKCI. Demographic and clinical information was documented. Echocardiography, a resting electrocardiography and 24 h ambulatory Holter monitoring electrocardiography were done. Chi square test was used to determine association between variables and those with a p value ≤ 0.2 were entered in a multivariate logistic regression analysis to determine the independent factors associated with arrhythmias. P value of < 0.05 was considered statistically significant. The receiver operating curve was used to determine the critical point for left atrial size beyond which arrhythmias develop.
A total of 390 patients were included in the analysis. The median age was 39 years interquartile range (IQR 30-52). Females were 257/390 (65.9%). Asymptomatic patients were 208/390 (53.3%). Most patients belonged to New York heart Association (NYHA) functional class I&II 247/390 (62.1%). The most common valve lesion was mitral stenosis 228/390 (58.5%). Arrhythmias were found in 276/390 (70.77%) patients, of which 193/390 (49.5%) patients were from resting electrocardiography (ECG) and 88/197 (44.7%) patients from holter ECG. Independent factors for arrhythmias were, NYHA functional class III&IV (a0R 4.67, 95% CI 1.82-12.00 p = < 0.01) and severe left atrial diameter enlargement (aOR 7.28, 95% CI 3.17-16.70 p = < 0.01). The critical point beyond which arrhythmias develop was found to be left atrium diameter > 48 mm.
We found a high prevalence of arrhythmias among patients with RHD. The independent predictors of arrhythmias were left atrium dilatation and NYHA functional class III-IV. We recommend close monitoring for arrhythmias among RHD patients in sinus rhythm with higher NYHA functional class and dilated left atrium.
心律失常是风湿性心脏病（RHD）的已知并发症。重要的是要尽早识别心律失常，以便在治疗这些患者时可以考虑采取及时的预防措施和进行密切监测。
本研究旨在确定在雅库伊·卡伊特心脏研究所（JKCI）就诊的 RHD 患者中心律失常的患病率、临床特征和超声心动图参数。
对在 JKCI 接受超声心动图诊断为 RHD 的 390 名年龄在 18 岁及以上的患者进行了一项基于医院的横断面研究。记录了人口统计学和临床信息。进行了超声心动图、静息心电图和 24 小时动态 Holter 监测心电图检查。卡方检验用于确定变量之间的关联，p 值≤0.2 的变量将被纳入多变量逻辑回归分析，以确定与心律失常相关的独立因素。p 值<0.05 被认为具有统计学意义。使用接收者操作曲线确定左心房大小的临界点，超过该临界点会发生心律失常。
共纳入 390 例患者进行分析。中位年龄为 39 岁（四分位距 30-52）。女性 257/390（65.9%）。无症状患者 208/390（53.3%）。大多数患者属于纽约心脏协会（NYHA）功能分级 I&II 247/390（62.1%）。最常见的瓣膜病变是二尖瓣狭窄 228/390（58.5%）。心律失常见于 276/390（70.77%）患者，其中 193/390（49.5%）患者来自静息心电图（ECG），88/197（44.7%）患者来自 Holter ECG。心律失常的独立因素是 NYHA 功能分级 III&IV（a0R 4.67，95%CI 1.82-12.00 p<0.01）和严重左心房直径增大（aOR 7.28，95%CI 3.17-16.70 p<0.01）。发现心律失常发生的临界点为左心房直径>48mm。
我们发现 RHD 患者心律失常的患病率很高。心律失常的独立预测因素是左心房扩张和 NYHA 功能分级 III-IV。我们建议对窦性心律、NYHA 功能分级较高和左心房扩大的 RHD 患者进行密切监测心律失常。
