Williamson Jacqueline M, Whalley Gillian A, Marangou James, Morris Peter S, Wang Zhiqiang, Francis Joshua R, Remenyi Bo
Menzies School of Health Research, 105 Rocklands Dr, Tiwi, NT, 0810, Australia.
Charles Darwin University, Casuarina, NT, Australia.
Pediatr Cardiol. 2025 Sep 3. doi: 10.1007/s00246-025-03966-7.
Rheumatic heart disease (RHD) is a chronic complication of acute rhematic fever (ARF). Echocardiography is used to assess valve disease in ARF. Acute valvulitis in ARF may normalise once inflammation has subsided. In the Top End of the Northern Territory (NT), a diagnosis of RHD is regularly made in conjunction with ARF diagnosis. We aimed to determine if baseline echocardiogram features could predict resolution of RHD when diagnosed during ARF. This retrospective cohort study includes children and young Australians diagnosed concurrently with first ARF and RHD between January 2012 and December 2021. Echocardiograms were reclassified based on the 2023 World Heart Federation guidelines for diagnosis of RHD. Primary outcome was echocardiographic resolution of RHD. The NT register recorded 311 individuals with concurrent diagnoses of ARF and RHD with 165 eligible for inclusion. Median age was 10 years (IQR 8-13 years), and 51.5% were female. Early RHD was diagnosed in 64% (106/165) of cases. Median follow-up time was 34 months. Resolution of RHD occurred in 19% (32/165) and 97% (31/32) of those had Early RHD at diagnosis. Absence of mitral valve leaflet thickening, restriction, and excessive leaflet motion were all associated with RHD resolution with univariate analysis. Multivariate Cox proportional modelling found that Early RHD at baseline independently predicted RHD resolution with HR of 16.6 (95% CI 2.25-122.74, p = 0.006). No difference was found between Stage A or Stage B RHD, (p = 0.461). The morphological features of valve disease were not as important as the severity in predicting resolution of RHD.
风湿性心脏病（RHD）是急性风湿热（ARF）的一种慢性并发症。超声心动图用于评估ARF中的瓣膜疾病。ARF中的急性瓣膜炎在炎症消退后可能恢复正常。在北领地（NT）的顶端地区，RHD的诊断通常与ARF的诊断同时进行。我们旨在确定基线超声心动图特征是否能够预测在ARF期间诊断出的RHD的恢复情况。这项回顾性队列研究纳入了2012年1月至2021年12月期间同时被诊断为首次ARF和RHD的澳大利亚儿童和年轻人。根据2023年世界心脏联合会RHD诊断指南对超声心动图进行重新分类。主要结局是RHD的超声心动图恢复情况。NT登记册记录了311例同时诊断为ARF和RHD的个体，其中165例符合纳入标准。中位年龄为10岁（四分位间距8 - 13岁），51.5%为女性。64%（106/165）的病例被诊断为早期RHD。中位随访时间为34个月。19%（32/165）的RHD得到恢复，其中97%（31/32）在诊断时为早期RHD。单因素分析显示，二尖瓣叶增厚、受限和瓣叶运动过度的缺失均与RHD的恢复相关。多变量Cox比例模型发现，基线时的早期RHD独立预测RHD的恢复，风险比为16.6（95%置信区间2.25 - 122.74，p = 0.006）。A期或B期RHD之间未发现差异（p = 0.461）。在预测RHD的恢复方面，瓣膜疾病的形态特征不如严重程度重要。
