Vieira Paulo Pinto Alves Campos, Pereira Rodrigo Furtado, Branco Carlos Eduardo Barros, Rosa Vitor Emer Egypto, Vieira Marcelo Luiz Campos, Demarchi Lea Maria Macruz Ferreira, Silva Livia Santos, Guilherme Luiza, Tarasoutchi Flavio, Sampaio Roney Orismar
Campus 1 Interlagos, Santo Amaro University, Sao Paulo 04829-300, Brazil.
Clinical Hospital (HC), São Paulo University Medical School, Sao Paulo 05403-000, Brazil.
Diagnostics (Basel). 2023 Oct 19;13(20):3252. doi: 10.3390/diagnostics13203252.
Rheumatic fever (RF) and rheumatic heart disease (RHD) are still highly prevalent, particularly in low- and middle-income countries. RHD is a neglected and underdiagnosed disease for which no specific laboratory diagnostic test is completely reliable. This is a retrospective observational study, which included 118 patients with RHD who underwent cardiac surgery from 1985 to 2018. The aim of this investigation was to evaluate the clinical, epidemiological, echocardiographic and pathological characteristics in two cohorts of RHD patients: one cohort with Aschoff bodies present in their pathological results and the other without such histopathological characteristics. No conventional clinical and laboratory tests for RHD myocarditis were able to identify active carditis during the preoperative phase of valve repair or replacement. Patients who had Aschoff bodies in their pathological results were younger (median age of 13 years (11-24 years) vs. 27 years (17-37 years), = 0.001) and had higher rate of late mortality (22.9% vs. 5.4%, = 0.043). In conclusion, the presence of Aschoff bodies in pathological findings may predict increased long-term mortality, emphasizing the importance of comprehensive pathology analysis for suspected myocarditis during heart surgery.
风湿热（RF）和风湿性心脏病（RHD）仍然非常普遍，尤其是在低收入和中等收入国家。风湿性心脏病是一种被忽视且诊断不足的疾病，目前尚无完全可靠的特异性实验室诊断测试。这是一项回顾性观察研究，纳入了1985年至2018年期间接受心脏手术的118例风湿性心脏病患者。本研究的目的是评估两组风湿性心脏病患者的临床、流行病学、超声心动图和病理特征：一组病理结果中有阿绍夫小体，另一组没有此类组织病理学特征。对于风湿性心脏病心肌炎，术前瓣膜修复或置换阶段没有常规临床和实验室检查能够识别活动性心肌炎。病理结果中有阿绍夫小体的患者更年轻（中位年龄13岁（11 - 24岁）vs. 27岁（17 - 37岁），P = 0.001），晚期死亡率更高（22.9% vs. 5.4%，P = 0.043）。总之，病理结果中阿绍夫小体的存在可能预示长期死亡率增加，强调了心脏手术期间对疑似心肌炎进行全面病理分析的重要性。
