Journal article
Left ventricular remodelling in rheumatic heart disease - trends over time and implications for follow-up in childhood
BMC cardiovascular disorders, Vol.23(1), 462
2023
PMID: 37715115
Abstract
Background
Rheumatic heart disease (RHD) is the most common form of acquired heart disease worldwide. In RHD, volume loading from mitral regurgitation leads to left ventricular (LV) dilatation, increased wall stress, and ultimately LV dysfunction. Improved understanding of LV dynamics may contribute to refined timing of intervention. We aimed to characterize and compare left ventricular remodelling between rheumatic heart disease (RHD) severity groups by way of serial echocardiographic assessment of volumes and function in children.
Methods
Children with RHD referred to Perth Children’s Hospital (formally Princess Margaret Hospital) (1987–2020) were reviewed. Patients with longitudinal pre-operative echocardiograms at diagnosis, approximately 12 months and at most recent follow-up, were included and stratified into RHD severity groups. Left ventricular (LV) echocardiographic parameters were assessed. Adjusted linear mixed effect models were used to compare interval changes.
Results
146 patients (median age 10 years, IQR 6–14 years) with available longitudinal echocardiograms were analysed. Eighty-five (58.2%) patients had mild, 33 (22.6%) moderate and 28 (19.2%) severe RHD at diagnosis. Mean duration of follow-up was 4.6 years from the initial diagnosis. Severe RHD patients had significantly increased end-systolic volumes (ESV) and end-diastolic volumes (EDV) compared to mild/moderate groups at diagnosis (severe versus mild EDV mean difference 27.05 ml/m2, p < 0.001, severe versus moderate EDV mean difference 14.95 ml/m2, p = 0.006). Mild and moderate groups experienced no significant progression of changes in volume measures. In severe RHD, LV dilatation worsened over time. All groups had preserved cardiac function.
Conclusions
In mild and moderate RHD, the lack of progression of valvular regurgitation and ventricular dimensions suggest a stable longer-term course. Significant LV remodelling occurred at baseline in severe RHD with progression of LV dilatation over time. LV function was preserved across all groups. Our findings may guide clinicians in deciding the frequency and timing of follow-up and may be of clinical utility during further reiterations of the Australia and New Zealand RHD Guidelines.
Details
- Title
- Left ventricular remodelling in rheumatic heart disease - trends over time and implications for follow-up in childhood
- Authors/Creators
- Bradley MacDonald - The Kids Research Institute AustraliaAdrian Tarca - Princess Margaret Hospital for ChildrenLouise Causer - Princess Margaret Hospital for ChildrenKatie Maslin - Princess Margaret Hospital for ChildrenDi Bruce - Princess Margaret Hospital for ChildrenRachel Schreiber-Wood - Princess Margaret Hospital for ChildrenMohit Kumar - The University of Western AustraliaJames Ramsay - Princess Margaret Hospital for ChildrenDavid Andrews - Princess Margaret Hospital for ChildrenCharley Budgeon - The University of Western AustraliaJudith Katzenellenbogen - The Kids Research Institute AustraliaAsha C. Bowen - The Kids Research Institute AustraliaJonathan Carapetis - The Kids Research Institute AustraliaMark K. Friedberg - University of TorontoDeane Yim - Princess Margaret Hospital for Children
- Publication Details
- BMC cardiovascular disorders, Vol.23(1), 462
- Publisher
- Springer Nature
- Number of pages
- 8
- Grant note
- We acknowledge and thank the members of the cardiology department (medical, nursing, echocardiography technician and administrative staff) who have coordinated the reviews of these patients over decades. We acknowledge the children and their families who l Aboriginal and Torres Strait Islander Australians
- Identifiers
- 991005884939807891
- Copyright
- © The Author(s) 2023.
- Murdoch Affiliation
- Ngangk Yira Institute for Change
- Language
- English
- Resource Type
- Journal article
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