Molla Fikadu Alemiye, Ayalew Desalew Getahun, Astatk Hailemaryam Alemu, Teshager Abebe Worku, Legesse Gebrehiwot Lema, Agonafir Daniel Belay, Fentahun Shibabaw, Assefa Belete Sisay, Godada Tilahun Nega, Gebrehana Deresse Abebe, Tadesse Abilo
Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, P. O. Box 196, Gondar, Ethiopia.
Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia.
BMC Cardiovasc Disord. 2025 Mar 18;25(1):193. doi: 10.1186/s12872-025-04648-1.
Most Rheumatic heart disease patients present with advanced disease and complications, pulmonary hypertension being one of the main complications. The presence of pulmonary hypertension is independently associated with increased pre-operative and perioperative morbidity and mortality in RHD patients. There are only few studies that showed the magnitude of pulmonary hypertension in RHD patients. This study was done to know the magnitude and predictors of PH in RHD patients so that early identification and intervention can be done for those at risk to develop PH.
An institution-based retrospective study was conducted by reviewing medical records of patients at adult echocardiographic unit from September, 2018 to September, 2023. Systolic PAP > 35mmHg using 2D echocardiography was used to diagnose pulmonary hypertension. Bi-variable logistic regression analysis followed by multivariable logistic regression analysis was done using SPSS statistics 25. P value < 0.05 and 95% CI was used to determine significant association.
A total of 230 RHD patients were included during the study period between September 2018 and September 2023. Most patients were below the age of 35 years (68.3%) with median age of 28 years and interquartile range of 21 to 38 years. Among the study participants 72.2% were females and 67% of them were rural residents. PH prevalence among RHD patients was found to be 77.4% (95% CI: 71.4%, 82.6%). Most patients (51.3%) had severe PH (≥ 60mmHg), whereas Mild PH (36-44mmHg) was 7.4% and moderate PH (45-59mmHg) was 18.7%. PH was found to have significant association with severe MS (AOR = 5.31, 95%CI: 1.87, 15.06), moderate to severe MR (AOR = 2.68, 95% CI: 1.05, 6.84), NYHA functional class III and IV (AOR = 2.60, 95% CI: 1.01, 6.68) and Diuretics use (AOR = 4.43, 95% CI: 1.33, 14.70).
The prevalence of PH among rheumatic heart disease patients in this study was high. Moderate to severe MR, severe MS, NYHA class III and IV, and diuretics use were significantly associated with PH. Expanding surgical intervention to address this patients is needed to decrease PH prevalence and morbidity and mortality associated with it.
大多数风湿性心脏病患者就诊时已处于疾病晚期并伴有并发症，肺动脉高压是主要并发症之一。肺动脉高压的存在与风湿性心脏病患者术前及围手术期发病率和死亡率增加独立相关。仅有少数研究显示了风湿性心脏病患者肺动脉高压的严重程度。本研究旨在了解风湿性心脏病患者肺动脉高压的严重程度及预测因素，以便对有发生肺动脉高压风险的患者进行早期识别和干预。
通过回顾2018年9月至2023年9月在成人超声心动图科室患者的病历，进行了一项基于机构的回顾性研究。使用二维超声心动图诊断收缩期肺动脉压>35mmHg为肺动脉高压。使用SPSS统计软件25进行双变量逻辑回归分析，随后进行多变量逻辑回归分析。P值<0.05和95%置信区间用于确定显著相关性。
在2018年9月至2023年9月的研究期间，共纳入230例风湿性心脏病患者。大多数患者年龄在35岁以下（68.3%），中位年龄为28岁，四分位间距为21至38岁。研究参与者中72.2%为女性，其中67%为农村居民。风湿性心脏病患者中肺动脉高压的患病率为77.4%（95%置信区间：71.4%，82.6%）。大多数患者（51.3%）患有重度肺动脉高压（≥60mmHg），而轻度肺动脉高压（36 - 44mmHg）为7.4%，中度肺动脉高压（45 - 59mmHg）为18.7%。发现肺动脉高压与重度二尖瓣狭窄（比值比=5.31，95%置信区间：1.87，15.06）、中度至重度二尖瓣反流（比值比=2.68，95%置信区间：1.05，6.84）、纽约心脏病协会功能分级III级和IV级（比值比=2.60，95%置信区间：1.01，6.68）以及使用利尿剂（比值比=4.43，95%置信区间：1.33，14.70）显著相关。
本研究中风湿性心脏病患者肺动脉高压的患病率较高。中度至重度二尖瓣反流、重度二尖瓣狭窄、纽约心脏病协会分级III级和IV级以及使用利尿剂与肺动脉高压显著相关。需要扩大手术干预以治疗这些患者，以降低肺动脉高压的患病率及其相关的发病率和死亡率。
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