1
|
Lupieri A, S A Passos L, Levine RA, Nizet V, Aikawa E. Lymphangiogenesis in Rheumatic Heart Valve Disease: A New Factor in the Pathogenic Conundrum. Arterioscler Thromb Vasc Biol 2024; 44:822-825. [PMID: 38357818 PMCID: PMC10978236 DOI: 10.1161/atvbaha.124.320708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Adrien Lupieri
- The Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.L., L.S.A.P., E.A.)
- Harvard Medical School, Boston, MA (A.L., L.S.A.P., R.A.L., E.A.)
| | - Livia S A Passos
- The Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.L., L.S.A.P., E.A.)
- Harvard Medical School, Boston, MA (A.L., L.S.A.P., R.A.L., E.A.)
| | - Robert A Levine
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Boston, MA (R.A.L.)
- Harvard Medical School, Boston, MA (A.L., L.S.A.P., R.A.L., E.A.)
| | - Victor Nizet
- Department of Pediatrics and Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California San Diego, La Jolla (V.N.)
| | - Elena Aikawa
- The Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (A.L., L.S.A.P., E.A.)
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA (E.A.)
- Harvard Medical School, Boston, MA (A.L., L.S.A.P., R.A.L., E.A.)
| |
Collapse
|
2
|
Safiri S, Mousavi SE, Noori M, Nejadghaderi SA, Sullman MJM, Singh K, Kolahi AA. The burden of rheumatic heart disease in the Middle East and North Africa region, 1990-2019. Arch Cardiovasc Dis 2023; 116:542-554. [PMID: 37863752 DOI: 10.1016/j.acvd.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a treatable and preventable condition resulting from acute rheumatic fever. AIM To report the prevalence, mortality and disability-adjusted life-years (DALY) due to RHD in the Middle East and North Africa (MENA) region from 1990 to 2019, by sex, age group, country and sociodemographic index (SDI). METHODS Information on the prevalence, mortality and DALY associated with RHD were obtained from the Global Burden of Disease Study 2019. Data were gathered for all countries in the MENA region over the period 1990-2019. These data included counts and age-standardized rates per 100,000, accompanied by 95% uncertainty intervals (UIs). RESULTS The MENA region had an age-standardized point prevalence of 388.9 per 100,000 in 2019, which was 5.4% higher than in 1990. The annual incidence rate was 1.6, which was 63.4% lower than in 1990. There were 379.4 thousand DALY attributable to RHD in 2019, with an age-standardized rate of 67.1, which was 61.3% lower than in 1990. In 2019, an estimated 7.4 thousand deaths were due to RHD, and the age-standardized death rate was 63.4% lower in 2019 than in 1990. DALY rates rose steadily with increasing age in both males and females. The SDI correlated negatively with the rate of DALY for RHD throughout the study period. CONCLUSION The burden of RHD in MENA declined from 1990 to 2019, demonstrating the importance of regularly updating health data and identifying risk factors, and developing effective guidelines on prevention.
Collapse
Affiliation(s)
- Saeid Safiri
- Clinical Research Development Unit of Tabriz-Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran; Clinical Research Development Unit of Tabriz-Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Seyed Ehsan Mousavi
- Neurosciences Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran; Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Maryam Noori
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Aria Nejadghaderi
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran; Systematic Review and Meta-analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mark J M Sullman
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus; Department of Social Sciences, University of Nicosia, Nicosia, Cyprus
| | - Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia; Department of Medicine, Griffith University, Southport, Queensland, Australia
| | - Ali-Asghar Kolahi
- Social Determinants of Health Research Center, Shahid-Beheshti University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
3
|
Simpson MT, Kachel M, Neely RC, Erwin WC, Yasin A, Patel A, Rao DP, Pandey K, George I. Rheumatic Heart Disease in the Developing World. Struct Heart 2023; 7:100219. [PMID: 38046860 PMCID: PMC10692356 DOI: 10.1016/j.shj.2023.100219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/01/2023] [Accepted: 08/03/2023] [Indexed: 12/05/2023]
Abstract
Despite recent public policy initiatives, rheumatic heart disease (RHD) remains a major source of morbidity worldwide. Rheumatic heart disease occurs as a sequela of Streptococcus pyogenes (group A streptococcal [GAS]) infection in patients with genetic susceptibility. Strategies for prevention of RHD or progression of RHD include prevention of GAS infection with community initiatives, effective treatment of GAS infection, and secondary prophylaxis with intramuscular penicillin. The cardiac surgical community has attempted to improve the availability of surgery in RHD-endemic areas with some success, and operative techniques and outcomes of valve repair continue to improve, potentially offering patients a safer, more durable operation. Innovation offers hope for a more scalable solution with improved biomaterials and transcatheter delivery technology; however, cost remains a barrier.
Collapse
Affiliation(s)
- Michael T. Simpson
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Mateusz Kachel
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | | | - W. Clinton Erwin
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | - Aleena Yasin
- Department of Cardiothoracic Surgery, Stanford University, Palo Alto, California, USA
| | - Amisha Patel
- Division of Cardiology, Mount Sinai Medical Center, New York, New York, USA
| | - Dasari Prasada Rao
- Department of Cardiothoracic Surgery, Apollo Spectra Hospital, Hyderabad, India
| | - Kaushal Pandey
- Centre for Cardiac Care, Hinduja Hospital, Mumbai, India
| | - Isaac George
- Division of Cardiac, Thoracic and Vascular Surgery, Department of Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| |
Collapse
|
4
|
Kotit S, Yacoub MH. The Aswan Rheumatic heart disease reGIstry: rationale and preliminary results of the ARGI database. Front Cardiovasc Med 2023; 10:1230965. [PMID: 37795482 PMCID: PMC10545855 DOI: 10.3389/fcvm.2023.1230965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/31/2023] [Indexed: 10/06/2023] Open
Abstract
Background Rheumatic Heart Disease (RHD) remains a major cause of valvular heart disease related mortality and morbidity in low- and middle-income countries, with significant variation in characteristics and course of the disease across different regions. However, despite the high disease burden, there is sparse region-specific data on demographics, disease characteristics and course in treated and untreated patients to guide policy. Methods The ARGI database is a hospital-based registry in a tertiary referral national centre (Aswan Heart Centre, AHC) in which all patients with the diagnosis of RHD are being included. The mode of presentation, including baseline clinical and echocardiographic characteristics (as well as other imaging modalities), biomarkers and genetics are being documented. Treatment modalities and adherence to treatment is being recorded and patients are followed up regularly every 6 and/or 12 months, or more frequently if needed. Discussion This study shows for the first time an in-depth analysis of the severity and phenotype of disease in Egyptian patients presenting with RHD as well as the progression with time and provides a platform for further comparisons of regional differences in these details as well as their causes. The ARGI database will be of help in achieving the objectives of the Cairo Accord aiming at eradication of RF and RHD.
Collapse
Affiliation(s)
| | - Magdi H. Yacoub
- Heart Science Centre, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| |
Collapse
|
5
|
Jaimes-reyes MA, Urina-jassir M, Urina-triana M, Urina-triana M. Current Situation of Acute Rheumatic Fever and Rheumatic Heart Disease in Latin America and the Caribbean: A Systematic Review. Glob Heart 2022; 17:65. [PMID: 36199563 PMCID: PMC9438465 DOI: 10.5334/gh.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/06/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Rheumatic heart disease (RHD) disproportionately affects low-income and middle-income countries. Latin America and the Caribbean (LAC) have been less represented in scientific literature. We aimed to describe the epidemiology, burden and implemented screening and prevention strategies of RHD in LAC. Methods: We systematically searched PubMed, Embase, LILACS, and SciELO from 1990 to April 2021. Observational and experimental studies that described data on the epidemiology, burden, or prevention/screening strategies of RHD, regardless of age or language, were included. The risk of bias was assessed by previously published tools depending on their study design. Pre-specified data were independently extracted and presented by each topic (epidemiology, burden, prevention/screening). PROSPERO registration number: CRD42021250043. Results: Forty-eight studies out of 1692 non-duplicate records met the eligibility criteria. They were mainly from Brazil, observational in design, and hospital-based. Data on the epidemiology of acute rheumatic fever (ARF) was not recent (most before 2000) with studies describing decreasing incidence through the years. The prevalence of RHD was described in six studies, ranging from 0.24 to 48 per 1,000 among studies evaluating schoolchildren. Nine studies described data based on admissions, ranging from 0.04% to 7.1% in single-center studies. Twenty-four studies assessed the burden of RHD with most of them reporting mortality rates/proportions and complications such as the need for intervention, atrial fibrillation, or embolism. Six preventive strategies were identified that included educational, register-based, and/or secondary prophylaxis strategies. Three well-established echocardiographic screening studies in Brazil and Peru were identified. Conclusions: Most ARF/RHD research in LAC comes from a single country, Brazil where preventive/screening efforts have been conducted. There was a paucity of data from several countries in the region, reflecting the need for epidemiological studies from more countries in LAC which will provide a better picture of the current situation of ARF/RHD and guide the implementation of preventive strategies.
Collapse
|
6
|
Arvind B, Saxena A. Rheumatic Heart Disease in India: Has It Declined or been Forgotten? Indian J Pediatr 2022; 89:637-638. [PMID: 35579842 DOI: 10.1007/s12098-022-04188-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Balaji Arvind
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
- Vice Chancellor, Pt. BD Sharma University of Health Sciences, Rohtak, Haryana, 124001, India.
| |
Collapse
|
7
|
Afifi A, Shehata N, Nagi M, Sultan AR, Yacoub M. Expanding Valve Repair in Rheumatic Heart Disease. Front Cardiovasc Med 2022; 8:799652. [PMID: 35187111 PMCID: PMC8854295 DOI: 10.3389/fcvm.2021.799652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/20/2021] [Indexed: 11/13/2022] Open
Abstract
Rheumatic heart disease is a serious ailment with significant morbidity and mortality in endemic areas; yet, there is no agreement on indication, timing, and surgical modality for treating rheumatic valve affection. There is mounting evidence that rheumatic mitral valve repair is possible with good long-term results, less is the case with rheumatic aortic valve disease. We discuss the surgical approach for both valves emphasizing the role of multimodality imaging.
Collapse
Affiliation(s)
- Ahmed Afifi
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
- *Correspondence: Ahmed Afifi
| | - Nairouz Shehata
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | - Mohamed Nagi
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
| | | | - Magdi Yacoub
- Magdi Yacoub Heart Foundation-Aswan Heart Centre, Cairo, Egypt
- Department of Biomedical Engineering, Imperial College London, London, United Kingdom
| |
Collapse
|
8
|
Gemechu T, Parry EHO, Yacoub MH, Phillips DIW, Kotit S. Community-based prevalence of rheumatic heart disease in rural Ethiopia: Five-year follow-up. PLoS Negl Trop Dis 2021; 15:e0009830. [PMID: 34644305 PMCID: PMC8513824 DOI: 10.1371/journal.pntd.0009830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As little is known about the prevalence and clinical progression of subclinical (latent) rheumatic heart disease (RHD) in sub-Saharan Africa, we report the results of a 5 year follow-up of a community based, echocardiographic study of the disease, originally carried out in a rural area around Jimma, Ethiopia. METHODS Individuals with evidence of RHD detected during the baseline study as well as controls and their family members were screened with a short questionnaire together with transthoracic echocardiography. RESULTS Of 56 individuals with RHD (37 definite and 19 borderline) in the original study, 36 (26 definite and 10 borderline) were successfully located 57.3 (range 44.9-70.7) months later. At follow-up two thirds of the definite cases still had definite disease; while a third had regressed. Approximately equal numbers of the borderline cases had progressed and regressed. Features of RHD had appeared in 5 of the 60 controls. There was an increased risk of RHD in the family relatives of borderline and definite cases (3.8 and 4.0 times respectively), notably among siblings. Compliance with penicillin prophylaxis was very poor. CONCLUSIONS We show the persistence of echocardiographically demonstrable RHD in a rural sub-Saharan population. Both progression and regression of the disease were found; however, the majority of the individuals who had definite features of RHD had evidence of continuing RHD lesions five years later. There was an increased risk of RHD in the family relatives of borderline and definite cases, notably among siblings. The findings highlight the problems faced in addressing the problem of RHD in the rural areas of sub-Saharan Africa. They add to the evidence that community-based interventions for RHD will be required, together with appropriate ways of identifying active disease, achieving adequate penicillin prophylaxis and developing vaccines for primary prevention.
Collapse
Affiliation(s)
| | | | - Magdi H. Yacoub
- Aswan Heart Centre, Aswan, Egypt
- NHLI, Heart Science Centre, Imperial College London, London, United Kingdom
| | - David I. W. Phillips
- Developmental Origins of Health and Disease Division, University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - Susy Kotit
- Aswan Heart Centre, Aswan, Egypt
- * E-mail:
| |
Collapse
|