Impact of Rheumatic Process in Left and Right Ventricular Function in Patients with Mitral Regurgitation

A predictive model for early postoperative hypoxemia after mitral valve replacement combined with pulmonary arterial hypertension

BACKGROUND

To establish and validate a novel scoring system on the basis of a nomogram for preoperative prediction of early hypoxemia after mitral valve replacement combined with pulmonary arterial hypertension.

METHODS

For this retrospective cohort study, clinical data from 430 patients with mitral valve disease combined with pulmonary arterial hypertension were collected. Early postoperative hypoxemia was defined as hypoxemia that occurred within 24 hours after operation. Clinical data from 430 patients were subjected to univariate logistic regression analysis (P < .05), and the results were then included in a stepwise multivariate logistic regression analysis (P < .05) to derive independent risk factors for postoperative hypoxemia. All the data from 430 patients were randomly divided into the training and validation cohorts. Nomogram prediction models for postoperative hypoxemia were established using the training cohorts and validated with the validation cohorts.

RESULTS

Univariate and stepwise multivariate logistic regression analyses suggested that the systolic pulmonary artery pressure, smoking, age, left atrial end-systolic dimension, and whether patients with accompanying atrial fibrillation underwent maze surgery (we replaced this factor with "atrial fibrillation-maze category" in the article that follows) were independent risk factors. A nomogram prediction model was developed accordingly. The area under the curve values of the training and validation cohorts were 0.838 (95% confidence interval, 0.783-0.892) and 0.799 (95% confidence interval, 0.730-0.869), respectively. The calibration curves were close to the ideal diagonal, and the decision curve analysis indicated a significant net benefit.

CONCLUSION

The risk prediction model developed in this study is a desirable predictor of early postoperative hypoxemia after mitral valve replacement combined with pulmonary arterial hypertension.

Characteristics and Problems of Rheumatic Heart Disease in Indonesia: The Ina-RHD Multicenter Study

BACKGROUND

Rheumatic heart disease (RHD) presents a significant public health challenge. Unfortunately, there is a lack of national data regarding the incidence and prevalence of RHD in Indonesia.

OBJECTIVES

The purpose of this study was to evaluate the characteristics, burdens, and problems of RHD in Indonesia.

METHODS

We collected medical reports of RHD patients over 18 years of age from 21 hospitals. Secondary data about clinical and echocardiography was collected to describe the characteristics, disease conditions, and complications of the disease.

RESULTS

We recruited 3,431 patients, average age was 44 years, and 64.4% (2,209 of 3,431) were women. Dyspnea was found in 85.7% (2,939 of 3,431), and 25% (862 of 3,431) of patients with NYHA functional class III to IV. Isolated mitral stenosis was the most prevalent valve lesion in 1,357 of 3,431 patients (39.6%). A total of 62.5 % (2,146 of 3,431) of patients had atrial fibrillation (AF), with the highest prevalence being in MV lesions. Vitamin K antagonist was prescribed in 2,411 of 3,431 (70.3%) of patients. A history of stroke was reported in 227 of 3,431 (6.6%) of patients and most frequently happened in isolated mitral stenosis patients 128 of 1,357 (9.4%). Finally, secondary prophylaxis was only administered in 1,279 of 3,431 (37.3%) of patients, and only 23.2% (796 of 3,431) had it regularly.

CONCLUSIONS

Our patients were predominantly women and had isolated mitral stenosis. Many patients came at a later stage of the disease, with older average age, a high prevalence of AF, pulmonary hypertension, and right heart involvement. The challenges were suboptimal use of anticoagulation despite the high prevalence of AF and underused secondary prophylaxis.

Upstream and Downstream Cardiovascular Changes in Rheumatic Mitral Stenosis: An Update

Rheumatic heart disease (RHD) and its complications are major health problems worldwide, especially in developing countries, owing to their high prevalence. Mitral stenosis (MS) is one of the most common lesions in RHD, either isolated or in combination with mitral regurgitation, and eventually leads to atrial fibrillation (AF), congestive heart failure, pulmonary hypertension (PH), and other complications, including ischemic stroke or limb ischemia, if not promptly diagnosed and treated. Recent studies have suggested that MS affects the cardiovascular system beyond mere obstructions. The presence of MS in RHD causes significant changes in the cardiovascular system, both upstream and downstream, affecting both the left and right ventricles. Rheumatic MS causes significant structural changes through inflammatory pathways and hemodynamic changes, owing to its obstructive effects. This review aims to discuss the vast changes in the cardiovascular system caused by rheumatic MS.

Echocardiographic Parameters and Complication Profiles Among Adult Patients with Rheumatic Heart Disease at Jimma Medical Center

Background

Despite the fact that patients with rheumatic heart disease (RHD) need early medical attention and follow-up, most patients in developing countries tend to present with debilitating complications. The objective of this study was to evaluate the echocardiographic features of adult individuals diagnosed with RHD and examine the associated complications among patients who started follow-up at Jimma Medical Center's (JMC) cardiac follow-up clinic.

Methods

A prospective cross-sectional study was conducted at JMC between January 5 and April 15, 2023. Echocardiographic patterns were taken by senior cardiologists; socio-demographic variables, anthropometric measurements, and behavioral factors were collected through a structured questioner.

Results

The study recruited a total of 115 participants, of whom 86 (74.8%) were female and 29 (25.2%) were male. The mean age of the patients was 32.31 (SD± 12.16) years. The mitral valve was affected in 98.26% of cases, while the aortic and tricuspid valve abnormalities were diagnosed in 49.5% and 21.7%, respectively. The most frequent combinations of valve lesions were mitral regurgitation (MR) + mitral stenosis (MS) + aortic regurgitation (AR) (15.7%), followed by MR + AR + TR (8.7%). The occurrence of MR+MS+AR was higher in females (17.4%) compared to males (10.3%), whereas the occurrence of MS+MR was higher in males (24.1%) compared to females (20.9%). Females have a severely reduced ejection fraction compared to males (84.8% vs 15.2%, P = 0.044). Nearly two-thirds (63.5%) of individuals experienced RHD-related complications; the most commonly encountered complications were pulmonary hypertension (26.1%) and atrial fibrillation (19.1%).

Conclusion

RHD predominantly affects individuals in their active and productive years, particularly females. Most patients have multiple-valve lesions.