Licciardi Francesco, Baldini Letizia, Del Monte Francesco, Geranzani Alice, Mulatero Roberta, Covizzi Carlotta, Scaioli Giacomo, Mazza Giuseppe Antonio, Montin Davide
Department of Public Health and Pediatrics, Università degli Studi di Torino, Piazza Polonia 94, 10126, Turin, Italy.
Immunorheumatology Unit, Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy.
Pediatr Cardiol. 2025 Jun;46(5):1289-1295. doi: 10.1007/s00246-024-03547-0. Epub 2024 Jun 19.
Describe the echocardiographic evolution of valvular regurgitation in patients with rheumatic carditis (RC) and to establish which features may predict long-term outcome, in the absence of acute rheumatic fever (ARF) relapse. Retrospective cohort study. 123 patients with confirmed RC, diagnosed at Turin Children's Hospital between 2010 and 2019. We reviewed the echocardiographic images recorded at diagnosis, after 6-8 weeks, after 6 months, then yearly, to assess which predictors at diagnosis are associated with the degree of improvement at 6 months. Secondly, we tested which variables predict the regression of pathological regurgitation of mitral (MV) or aortic valve (AV) during follow-up. At onset, 90.2% patients had MV regurgitation while 42.3% had AV involvement. 115 (93.5%) patients were treated with steroids and 70.8% experienced a downgrading of RC after 6 months. Steroids were associated with better outcomes at six months (p = 0.01). During follow-up (median 56.1 months), MV improved in 58.6% patients, AV in 46.2%. At multivariate analysis, erythrocyte sedimentation rate (ESR) was positively associated with regression of MV regurgitation (OR 1.02, p = 0.02), while higher degree of carditis at onset was negatively associated (OR 0.04, p < 0.01). Conversely, regression of AV regurgitation was more frequent in patients with bi-valvular involvement (OR 20.5, p = 0.03) and in absence of murmur at onset (OR 0.04, p = 0.01). This study indicates that valvular regurgitation improves overtime if there are no ARF recurrences during follow-up, especially when the MV is involved and in patients treated with steroids.
描述风湿性心脏炎（RC）患者瓣膜反流的超声心动图演变，并确定在无急性风湿热（ARF）复发的情况下哪些特征可预测长期预后。回顾性队列研究。123例确诊为RC的患者，于2010年至2019年在都灵儿童医院确诊。我们回顾了诊断时、6 - 8周后、6个月后以及随后每年记录的超声心动图图像，以评估诊断时的哪些预测因素与6个月时的改善程度相关。其次，我们测试了哪些变量可预测二尖瓣（MV）或主动脉瓣（AV）病理性反流在随访期间的消退情况。发病时，90.2%的患者有MV反流，而42.3%有AV受累。115例（93.5%）患者接受了类固醇治疗，6个月后70.8%的患者RC病情有所减轻。类固醇与6个月时更好的预后相关（p = 0.01）。在随访期间（中位时间56.1个月），58.6%的患者MV情况改善，46.2%的患者AV情况改善。多因素分析显示，红细胞沉降率（ESR）与MV反流的消退呈正相关（OR 1.02，p = 0.02），而发病时较高程度的心脏炎与之呈负相关（OR 0.04，p < 0.01）。相反，双瓣膜受累的患者（OR 20.5，p = 0.03）以及发病时无杂音的患者（OR 0.04，p = 0.01）中AV反流的消退更为常见。这项研究表明，如果随访期间没有ARF复发，瓣膜反流会随时间改善，尤其是当MV受累以及接受类固醇治疗的患者。
