Echocardiographic Assessment of Valvular Involvement in Chronic Rheumatic Heart Disease in BSMMU, Bangladesh.

Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years especially in the developing county like Bangladesh. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of sub-clinical disease. It has a progressive course and patients usually may require valve repair/replacement in future. Echocardiography is an easily available, non-invasive, widely used, standard tool for diagnosis and evaluation of RHD. But there is scarcity of echocardiographic study of Valvular Involvement in Chronic Rheumatic Heart Disease (CHRD) in Bangladesh. This study was aimed to utilize echocardiography as a tool to evaluate patients of CRHD in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. This observational study was conducted in the Department of Cardiology, BSMMU from September 2018 to August 2019. Echocardiography was done in each patient only once with VividE9®machine. Among 1350 echocardiography, 101 patients (7.5%) were diagnosed as RHD including post valve replacement patients. The mean age of the patients was 40±14 years and 64.34% were female. Mitral stenosis (MS) was the commonest lesion in 84.15% followed by mitral regurgitation (MR) in 66.33%, tricuspid regurgitation (TR) in 57.43%, aortic regurgitation (AR) in 49.51%, aortic stenosis (AS) in 26.74% and pulmonary regurgitation in 10.89%. The frequency of complications like pulmonary hypertension, heart failure, atrial fibrillation (AF), LA thrombus, stroke and infective endocarditis was 67.33%, 61.05%, 18.81%, 6.93%, 3.96% and 0.99% respectively. History of Rheumatic fever was present only in 10.89% patient. Mitral stenosis was the commonest lesion seen mostly in female and most common complication was pulmonary hypertension. Mean age of patients in this study was higher than other contemporary studies and frequency as well as severity of complications was also more in female.

Assessment of Risk Factors of Heart Failure: A Case Control Study.

Heart failure (HF) is becoming an increasingly prevalent healthcare problem. Besides, Ischemic heart disease (IHD) and Hypertension (HTN), there is a number of other factors that continue to evolve as risk factors for heart failure. The aim of the study was to identify the different risk factors of heart failure patients. This case-control study was conducted in the Department of Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh from August 2014 to July 2015. It was included 75 patients of heart failure (cases) and 75 age and sex matched adult individuals (friends and relations of heart failure cases) as controls. The risk factors studied were grouped into demographic, clinical, behavioral and biochemical variables. The age distribution between case and control groups was almost identical with mean ages of either group being 55 years (p=0.922). The sex distribution was also fairly comparable with male being predominant in both the groups (p=0.574). In this study IHD followed by uncontrolled hypertension (p=0.001) are came out to be the predominant risk factors of heart failure followed by smoking and obesity (p<0.001). From the findings of the study, it can be concluded that a number of risk factors are involved in heart failure cases. Of them ischemic heart disease and uncontrolled hypertension are the predominant ones followed by smoking and obesity. The best strategy would, therefore, be to treat and control ischemic heart disease, hypertension, obesity, diabetes and smoking habit in the population. However, as the risk factors in the population continue to change; ongoing surveillance is important to guide right preventive strategy in future.

Assessment of Subvalvular Apparatus in Patients with Rheumatic Mitral Stenosis: Comparison between 2D and 3D Echocardiography.

Mitral valve is the most involved valve in rheumatic heart disease especially in the form of mitral stenosis. Treatment options of mitral stenosis depend upon pattern, extent & the severity of disease and echocardiography has the key role in this area. Severity of involvement of subvalvular apparatus (SVA) is an important factor for determining the treatment option. 2D echocardiography (2DE) is conventionally used. With the advancement of echocardiographic technology 3D echocardiography (3DE) would offer better assessment of subvalvular apparatus. This study compared transthoracic 2D versus 3D echocardiography for assessment of SVA in chronic rheumatic mitral valve disease. This cross sectional observational study was done in University cardiac centre, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from May 2012 to October 2012. In this study, considering all ethical issues, data were collected from 50 subjects who underwent transthoracic 2D and 3D echocardiography for the assessment of extent and severity of mitral stenosis. Accurate measurement of Mitral valvular area is very important in assessment of severity, which is found similar by both 2DE (0.98±0.24cm²) and 3DE (0.92 ±0.23cm²). But assessment of subvalvular involvement especially chordal adhesion can be done better by 3DE (p<0.001). This observation suggests superiority of 3DE for assessment of SVA in chronic rheumatic mitral stenosis. The result of the study demonstrates that 3DE is superior to 2DE for the assessment of SVA in chronic rheumatic mitral stenosis.