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1.
West Afr J Med ; 38(3): 241-245, 2021 03 22.
Artigo em Inglês | MEDLINE | ID: mdl-33765372

RESUMO

BACKGROUND: Rheumatic valvular heart disease (RVHD) is one of the foremost causes of heart failure (HF) in our population, particularly among young adults, but a decline in the prevalence of RVHD has been observed. The effect of this decline on the relevance of RVHD among other causes of HF is not established in our setting. OBJECTIVE: To determine whether RVHD is still a leading cause of HF in our population or not. METHODS: This was a retrospective study of HF patients hospitalized between August 2018 and June 2020. The demographic features, blood pressure, aetiology of HF and ejection fraction were retrieved from the unit's HF register. Data were presented as frequencies and medians. Associations were tested as appropriate. RESULTS: RVHD accounted for 78 (35.5%) of HF, with a median age of 47 years. The young and middle- aged subgroups were 10(12.8%) and 48(61.6%), respectively. The affected valves were all regurgitant and 68 (77.2%) had definite RVHD. Isolated mitral valve, combined mitral and aortic valves were affected in 40 (51.3%) and 22 (28.2%), respectively. The median systolic blood pressure and ejection fraction were 110mmHg and 26% respectively. RVHD was associated with HF with reduced ejection fraction. (P value < 0.001). CONCLUSION: RVHD remains one of the leading causes of HF (35.5%) among adults in our population. Young adults are now in the minority and most patients present late in the course of the disease. Valve surgery should be made readily accessible. Primary and secondary prevention of acute rheumatic fever should be reinforced.


Assuntos
Insuficiência Cardíaca , Doenças das Valvas Cardíacas , Cardiopatia Reumática , Idoso , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Pessoa de Meia-Idade , Valva Mitral , Estudos Retrospectivos , Cardiopatia Reumática/complicações , Cardiopatia Reumática/epidemiologia , Adulto Jovem
2.
Autoimmun Rev ; 20(2): 102740, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33333234

RESUMO

Rheumatic heart disease (RHD) is a serious and long-term consequence of acute rheumatic fever (ARF), an autoimmune sequela of a mucosal infection by Streptococcus pyogenes (Group A Streptococcus, Strep A). The pathogenesis of ARF and RHD is complex and not fully understood but involves host and bacterial factors, molecular mimicry, and aberrant host innate and adaptive immune responses that result in loss of self-tolerance and subsequent cross-reactivity with host tissues. RHD is entirely preventable yet claims an estimated 320 000 lives annually. The major burden of disease is carried by developing nations and Indigenous populations within developed nations, including Australia. This review will focus on the epidemiology, pathogenesis and treatment of ARF and RHD in Australia, where: streptococcal pyoderma, rather than streptococcal pharyngitis, and Group C and Group G Streptococcus, have been implicated as antecedents to ARF; the rates of RHD in remote Indigenous communities are persistently among the highest in the world; government register-based programs coordinate disease screening and delivery of prophylaxis with variable success; and researchers are making significant progress in the development of a broad-spectrum vaccine against Strep A.


Assuntos
Febre Reumática , Cardiopatia Reumática , Infecções Estreptocócicas , Austrália , Humanos , Pesquisa , Febre Reumática/diagnóstico , Febre Reumática/epidemiologia , Febre Reumática/terapia , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/terapia , Infecções Estreptocócicas/epidemiologia , Streptococcus pyogenes
3.
Am J Cardiol ; 143: 118-124, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33352211

RESUMO

Mitral annular calcification (MAC) is a common echocardiographic finding and an increasingly recognized cause of degenerative mitral stenosis (DMS). However, little is known about the clinical characteristics and disease progression in DMS, particularly in comparison with rheumatic mitral stenosis (RMS). We retrospectively reviewed 203 consecutive patients with mitral stenosis (113 with DMS and 90 with RMS) who underwent echocardiography at our institution between January 2014 and December 2017. We compared the clinical characteristics and disease progression between the 2 groups. In addition, we analyzed the predictors of disease progression (defined as annual progression rate of a mean gradient >0 mm Hg/year) among patients with DMS. Patients with DMS were significantly older and had higher prevalence of atherosclerotic comorbidities than those with RMS. During the median follow-up period of 2.2 years, the annual progression rates were comparable (0.8 ± 0.8 mm Hg/year in DMS vs 1.0 ± 1.2 mm Hg/year in RMS; p = 0.32) and were highly variable (0.0 to 3.5 mm Hg/year in DMS and 0.0 to 5.5 mm Hg/year in RMS) within both groups among disease progression. In DMS patients, atherosclerotic comorbidities and lower initial mean gradient were significantly associated with disease progression even after adjustment by age and sex. There was no significant difference in the disease progression according to the circumferential MAC severity determined by echocardiography among DMS. In conclusion, DMS disease progression was slow but highly variable, similar to that of RMS. In patients with DMS, the baseline MAC severity did not correlate with disease progression, suggesting the importance of follow-up echocardiography regardless of the MAC severity.


Assuntos
Calcinose/diagnóstico por imagem , Estenose da Valva Mitral/diagnóstico por imagem , Cardiopatia Reumática/diagnóstico por imagem , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/epidemiologia , Calcinose/epidemiologia , Calcinose/fisiopatologia , Comorbidade , Doença da Artéria Coronariana/epidemiologia , Progressão da Doença , Ecocardiografia , Ecocardiografia Doppler , Feminino , Taxa de Filtração Glomerular , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/fisiopatologia , Humanos , Hipertensão/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/epidemiologia , Estenose da Valva Mitral/fisiopatologia , Prevalência , Pontuação de Propensão , Estudos Retrospectivos , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/fisiopatologia
4.
Pediatr Clin North Am ; 67(5): 843-853, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888685

RESUMO

Rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and mortality globally in children and young adults. This article focuses on prevention and management of RHD. Pregnancy can unmask previously undiagnosed RHD and poses high risk for mother and fetus. Management of anticoagulation is important. Definitive catheter and surgical intervention are the only treatments that can improve outcomes of patients with moderate or severe RHD. Access to intervention remains very limited in RHD endemic regions. There are ongoing global efforts to increase awareness, public policy adoption, and greater access to treatment.


Assuntos
Gerenciamento Clínico , Programas de Rastreamento/métodos , Cardiopatia Reumática , Criança , Progressão da Doença , Ecocardiografia , Saúde Global , Humanos , Morbidade , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/epidemiologia
5.
J Assoc Physicians India ; 68(10): 60-65, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32978928

RESUMO

Rheumatic heart disease (RHD) disables millions in Asia and Africa. Epidemiological data and clinical studies in India have reported a significant decline in its prevalence in last century. Global Burden of Disease (GBD) study estimated that RHD in India led to 395/100000 disability adjusted life years (DALYs) and 9.2/100000 deaths in 1990. This declined to 270/100000 and 7.9/100000, respectively, in 2017. School-based epidemiological studies in India have reported decline in clinically diagnosed RHD. On the other hand, GBD study has reported that in terms of absolute numbers, India contributes to one-third of global RHD burden. RHD in 1990 led to 3.44 million DALYs and 80,470 deaths which has increased to 3.73 million DALYs and 108,460 deaths in 2017. India Disease Burden Initiative has reported high RHD burden in many less developed states of the country, e.g., Bihar, Odisha, Assam, Chhattisgarh, Uttar Pradesh, etc. Echocardiographic epidemiology studies have reported high burden of subclinical RHD. Significant proportions of patients in hospital-based echocardiographic clinics have RHD and it contributes to 25-45% of cardiac surgeries in government hospitals. The continuing burden of RHD needs proper public health and clinical response.


Assuntos
Cardiopatia Reumática/epidemiologia , África , Ásia , Carga Global da Doença , Humanos , Índia/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida
6.
PLoS Negl Trop Dis ; 14(8): e0008558, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32804953

RESUMO

Rheumatic heart disease (RHD) as a chronic sequela of repeated episodes of acute rheumatic fever (ARF), remains a cause of cardiac morbidity in Egypt although it is given full attention through a national RHD prevention and control program. The present report reviews our experience with subjects presenting with ARF or its sequelae in a single RHD centre and describes the disease pattern over the last decade. A cross-sectional study was conducted in El-Mahalla RHD centre between 2006 and 2018. A total of 17014 individual were enrolled and evaluated. Diagnosis ARF was based on the 2015 revised Jones criteria and RHD was ruled in by echocardiography. The majority of the screened subjects were female (63.2%), in the age group 5-15 years (64.6%), rural residents (61.2%), had primary education (43.0%), and of low socioeconomic standard (50.2%). The total percentage of cases presenting with ARF sequelae was 29.3% [carditis/RHD (10.8%), rheumatic arthritis (Rh.A) (14.9%), and Sydenham's chorea (0.05%)]. Noticeably, 72% were free of any cardiac insult, of which 37.7% were victims of misdiagnoses made elsewhere by untrained practitioners who prescribed for them long term injectable long-acting penicillin [Benzathine Penicillin G (BPG)] without need. About 54% of the study cohort reported the occurrence of recurrent attacks of tonsillitis of which 65.2% underwent tonsillectomy. Among those who experienced tonsillectomy and/or received BPG in the past, 14.5% and 22.3% respectively had eventually developed RHD. Screening of family members of some RHD cases who needed cardiac surgery revealed 20.7% with undiagnosed ARF sequalae [RHD (56.0%) and Rh.A (52.2%)]. Upon the follow-up of RHD cases, 1.2% had improved, 98.4% were stable and 0.4% had their heart condition deteriorated. Misdiagnosis of ARF or its sequelae and poor compliance with BPG use may affect efforts being exerted to curtail the disease. Updating national guidelines, capacity building, and reliance on appropriate investigations should be emphasized. Since the genetic basis of RHD is literally confirmed, a family history of RHD warrants screening of all family members for early detection of the disease.


Assuntos
Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/prevenção & controle , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Progressão da Doença , Ecocardiografia , Egito , Feminino , Humanos , Programas de Rastreamento , Penicilina G Benzatina/uso terapêutico , Febre Reumática/prevenção & controle , Cardiopatia Reumática/epidemiologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-32751527

RESUMO

In Australia, disease registers for acute rheumatic fever (ARF) and rheumatic heart disease (RHD) were previously established to facilitate disease surveillance and control, yet little is known about the extent of case-ascertainment. We compared ARF/RHD case ascertainment based on Australian ARF/RHD register records with administrative hospital data from the Northern Territory (NT), South Australia (SA), Queensland (QLD) and Western Australia (WA) for cases 3-59 years of age. Agreement across data sources was compared for persons with an ARF episode or first-ever RHD diagnosis. ARF/RHD registers from the different jurisdictions were missing 26% of Indigenous hospitalised ARF/RHD cases overall (ranging 17-40% by jurisdiction) and 10% of non-Indigenous hospitalised ARF/RHD cases (3-28%). The proportion of hospitalised RHD cases (36%) was half the proportion of hospitalised ARF cases (70%) notified to the ARF/RHD registers. The registers were found to capture few RHD cases in metropolitan areas (SA Metro: 13%, QLD Metro: 35%, WA Metro: 14%). Indigenous status, older age, comorbidities, drug/alcohol abuse and disease severity were predictors of cases appearing in the hospital data only (p < 0.05); sex was not a determinant. This analysis confirms that there are biases associated with the epidemiological analysis of single sources of case ascertainment for ARF/RHD using Australian data.


Assuntos
Febre Reumática , Cardiopatia Reumática , Doença Aguda , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Northern Territory , Queensland/epidemiologia , Febre Reumática/epidemiologia , Cardiopatia Reumática/epidemiologia , Austrália do Sul , Austrália Ocidental/epidemiologia , Adulto Jovem
9.
Med J Aust ; 213(3): 118-123, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32632952

RESUMO

OBJECTIVES: Using echocardiographic screening, to estimate the prevalence of rheumatic heart disease (RHD) in a remote Northern Territory town. DESIGN: Prospective, cross-sectional echocardiographic screening study; results compared with data from the NT rheumatic heart disease register. SETTING, PARTICIPANTS: People aged 5-20 years living in Maningrida, West Arnhem Land (population, 2610, including 2366 Indigenous Australians), March 2018 and November 2018. INTERVENTION: Echocardiographic screening for RHD by an expert cardiologist or cardiac sonographer. MAIN OUTCOME MEASURES: Definite or borderline RHD, based on World Heart Federation criteria; history of acute rheumatic fever (ARF), based on Australian guidelines for diagnosing ARF. RESULTS: The screening participation rate was 72%. The median age of the 613 participants was 11 years (interquartile range, 8-14 years); 298 (49%) were girls or women, and 592 (97%) were Aboriginal Australians. Definite RHD was detected in 32 screened participants (5.2%), including 20 not previously diagnosed with RHD; in five new cases, RHD was classified as severe, and three of the participants involved required cardiac surgery. Borderline RHD was diagnosed in 17 participants (2.8%). According to NT RHD register data at the end of the study period, 88 of 849 people in Maningrida and the surrounding homelands aged 5-20 years (10%) were receiving secondary prophylaxis following diagnoses of definite RHD or definite or probable ARF. CONCLUSION: Passive case finding for ARF and RHD is inadequate in some remote Australian communities with a very high burden of RHD, placing children and young people with undetected RHD at great risk of poor health outcomes. Active case finding by regular echocardiographic screening is required in such areas.


Assuntos
Programas de Rastreamento/métodos , Grupo com Ancestrais Oceânicos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/etnologia , Cardiopatia Reumática/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Northern Territory/epidemiologia , Prevalência , Estudos Prospectivos , Febre Reumática/diagnóstico por imagem , Febre Reumática/epidemiologia , Febre Reumática/etnologia , Adulto Jovem
10.
PLoS One ; 15(6): e0234196, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32497088

RESUMO

BACKGROUND: The World Health Organisation previously recommended routine screening in school-aged children in countries with a high prevalence of rheumatic heart disease (RHD); however, it is unclear if screening-detected (latent) valve disease will inevitably evolve to a pathological lesion. Understanding the natural history of latent RHD is essential prior to recommendation of screening in endemic areas. Studies documenting the progression of latent RHD have had contrasting conclusions about the pathogenicity of latent valvular lesions. This review provides estimates of rates of progression of latent RHD. METHODS AND FINDINGS: In this systematic review and meta-analysis, we searched EMBASE, MEDLINE, Global Index Medicus, Africa Wide, Cochrane Database of Systematic Reviews and Global Health Database for studies published before April 30, 2019. Study data were extracted from all studies which reported follow-up data on progression of latent valve lesions. Studies with control cohorts were used to calculate comparative prevalence ratios. This study is registered with PROSPERO, number CRD42019119427. We identified 12 studies reporting follow-up data on latent RHD for 950 people in 9 countries. The estimated pooled prevalence rate for progression per year of latent RHD was 5%/year (95% CI 2-8). Eight studies reported on the progression of borderline latent RHD with an estimated pooled prevalence of 2%/year (95% CI 0-4). Three studies included control groups. There was a significant increase in the risk of progression of valvular disease in the latent group compared with controls (RR = 3.57 (95%CI = 1.65-7.70, P = 0.001). The overall risk of bias was low. Given most studies included penicillin administration we were unable to document the natural history of latent RHD. Furthermore, we were unable to perform a sensitivity analysis to determine the effect of administering penicillin prophylaxis on progression of valve disease given prescription of penicillin was not standardised. CONCLUSION: Latent RHD has a slow rate of progression but it is significantly higher compared to controls, with definite latent RHD having a higher rate of progression compared with borderline latent disease. There are a massive number of individuals at risk for RHD in the developing world as well as logistical challenges of screening and delivering penicillin prophylaxis. The low rate of progression from untargeted screening may be an important consideration in resource-constrained environments.


Assuntos
Progressão da Doença , Ecocardiografia , Doenças Endêmicas , Programas de Rastreamento/métodos , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/epidemiologia , Humanos
11.
Am J Cardiol ; 125(11): 1718-1724, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32284176

RESUMO

To analyze pregnancy outcomes of patients with heart disease in a single center and to explore the risk factors of adverse outcomes. One thousand thirty-three pregnant women with heart disease were retrospectively included from 2010 to 2017. We collected data of maternal, obstetric, and fetal outcomes. Among 1,086 pregnancies, 295 (27.1%) with congenital heart disease, 244 (22.5%) with rheumatic heart disease, 387 (35.6%) with arrhythmia, and 55 (5.1%) with cardiomyopathy. There were 8 (0.7%) maternal deaths. Risk factors of mortality were New York Heart Association (NYHA) classification IV (p <0.001), cardiac surgery during pregnancy (p <0.001), and general anesthesia (p <0.001). Maternal cardiac complications occurred in 6.7% of women, with most in the cardiomyopathy (26.0%) and rheumatic heart disease (32.9%) groups. Multivariate logistic regression modeling was used to analyze the potential risk factors. NYHA classification III and IV independently predicted worse maternal outcomes. Peripartum intensive care unit admission rate was 10.2%. Admission to intensive care unit was associated with NYHA classification II/III/IV, modified World Health Organization (mWHO) classification II-III/III/IV, and cardiac surgery during pregnancy. In conclusion, pregnancy with heart disease is at higher risk of complications for both women and neonates. In our findings, maternal morbidity is associated with NYHA classification and mWHO classification.


Assuntos
Arritmias Cardíacas/epidemiologia , Cardiomiopatias/epidemiologia , Cardiopatias Congênitas/epidemiologia , Mortalidade Materna , Mortalidade Perinatal , Complicações Cardiovasculares na Gravidez/epidemiologia , Nascimento Prematuro/epidemiologia , Cardiopatia Reumática/epidemiologia , Aborto Induzido , Aborto Espontâneo , Adulto , Procedimentos Cirúrgicos Cardíacos , China/epidemiologia , Feminino , Doenças das Valvas Cardíacas/epidemiologia , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Modelos Logísticos , Análise Multivariada , Hemorragia Pós-Parto/epidemiologia , Gravidez , Complicações Cardiovasculares na Gravidez/cirurgia , Estudos Retrospectivos , Índice de Gravidade de Doença , Tromboembolia Venosa/epidemiologia , Adulto Jovem
12.
Am J Cardiol ; 125(10): 1536-1542, 2020 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-32241552

RESUMO

Mitral stenosis is classically caused by rheumatic disease (RMS). However, degenerative mitral stenosis (DMS) is increasingly encountered, particularly in developed countries with aging populations. The aim of this study was to compare clinical and echocardiographic characteristics between the 2 entities. One hundred fifteen patients with DMS were identified from an echocardiographic database in the United States and compared with 510 patients with RMS from Seoul, Korea. All subjects had a mitral valve area (MVA) ≤2.5 cm2 by continuity equation but were otherwise unselected. Patients with DMS were older and had more hypertension, diabetes, chronic kidney disease, and chronic obstructive pulmonary disease than those with RMS. Atrial fibrillation was more common in RMS patients. Mean mitral valve gradient was slightly lower in DMS versus RMS (7.63 ± 3.67 vs 8.50 ± 4.23 mm Hg, p = 0.04) but MVA was strikingly higher in the DMS group (1.35 ± 0.41 vs 0.95 ± 0.38 cm2, p <0.0001). This appeared to be due to greater stroke volume in the DMS patients (70.4 ± 19.7 vs 55.7 ± 15.5 ml, p <0.0001). Indexed left atrial volume was greater in RMS (82.1 ± 40.3 vs 57.9 ± 21.4 ml, p <0.0001) while estimated pulmonary artery systolic pressure was greater in DMS (49.3 ± 16.5 vs 39.4 ± 13.6 mm Hg, p <0.0001). In conclusion, DMS patients are older and have more comorbidities than RMS patients. DMS presents with greater MVA relative to mean mitral valve gradient than RMS. This appears due to a higher stroke volume in DMS patients.


Assuntos
Estenose da Valva Mitral/fisiopatologia , Cardiopatia Reumática/fisiopatologia , Fatores Etários , Idoso , Comorbidade , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estenose da Valva Mitral/classificação , Estenose da Valva Mitral/diagnóstico por imagem , Estenose da Valva Mitral/epidemiologia , República da Coreia/epidemiologia , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/epidemiologia , Fatores de Risco , Estados Unidos/epidemiologia
13.
Arch Cardiovasc Dis ; 113(4): 252-262, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32070729

RESUMO

BACKGROUND: French Polynesia is a French overseas collectivity in the South Pacific Ocean, where data on infective endocarditis (IE) are lacking. AIMS: To investigate the epidemiology and outcomes of IE in French Polynesia. METHODS: All hospital records from consecutive patients hospitalized in Taaone Hospital, Tahiti, from 2015 to 2018, with an International Classification of Diseases, 10th revision, separation diagnosis of IE (I330), were reviewed retrospectively. RESULTS: From 190 hospital charts reviewed, 105 patients with a final diagnosis of IE, confirmed according to the modified Duke criteria, were included. The median duration of follow-up was 71 days (interquartile range 18-163 days). The mean age was 55±17 years, and there were 68 men (65%). Thirty-five patients (33%) had a history of rheumatic carditis and 43 (41%) had a prosthetic valve. There were 40 (38%) cases of staphylococcal IE, 32 (30%) of streptococcal IE and six (6%) of enterococcal IE. Cardiogenic shock, septic shock and clinically relevant cerebral complications were strongly associated with death from any cause (hazard ratio [HR] 16.85, 95% confidence interval [CI] 5.45-52.05 [P<0.001]; HR 2.62, 95% CI 1.23-5.56 [P=0.01]; and HR 4.14, 95% CI 1.92-8.92 [P<0.001], respectively). Seventy-three patients (69%) had a theoretical indication for surgery, which was performed in 38 patients (36%). Lack of surgery when there was a theoretical indication was significantly associated with death (HR 6.93, 95% CI 3.47-13.83; P<0.0001). CONCLUSIONS: The pattern of IE in French Polynesia differs from Western countries in many ways. Postrheumatic valvular disease remains the main underlying disease, and access to emergency heart surgery is still a challenge.


Assuntos
Antibacterianos/uso terapêutico , Endocardite/epidemiologia , Endocardite/terapia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas/efeitos adversos , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/terapia , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/terapia , Adulto , Idoso , Antibacterianos/efeitos adversos , Endocardite/diagnóstico , Endocardite/mortalidade , Feminino , Acesso aos Serviços de Saúde , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Polinésia/epidemiologia , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/mortalidade , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/mortalidade , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
14.
Anatol J Cardiol ; 23(2): 99-104, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32011322

RESUMO

OBJECTIVE: Cardiovascular disease (CVD) is the leading cause of death during pregnancy. Therefore, its detection early in pregnancy is of great importance. In this study, we aimed to investigate the rate and spectrum of CVD among healthy women in the first trimester of pregnancy. METHODS: A total of 900 women in the first trimester of pregnancy, who attended the antenatal outpatient clinic of a tertiary care center in Ankara, Turkey, for a routine pregnancy examination, were recruited into this prospective study. Patients with a history of chronic systemic diseases, CVD, and/or a family history of an early onset CVD, and multiple pregnancies were excluded. Patients who were included in the study underwent electrocardiography and transthoracic echocardiography by the same cardiologist. RESULTS: The rate of newly diagnosed CVD cases among asymptomatic pregnant women without any cardiac or clinical risk factors was 5.2% (n=47). The following CVDs were detected: rheumatic heart disease (n=26; 55.3%), congenital heart disease (n=13; 27.6%), and isolated valve disease (moderate and severe) (n=8; 17%). The mitral valve prolapse was detected in 32 women (3.5%) and atrial septal aneurysm in 51 women (5.67%). Thirty women (3.3%) had arrhythmia. CONCLUSION: The CVD rate of 5.2% among healthy women in the first trimester of pregnancy shows that the clinicians must keep in mind that during pregnancy, physiological changes in the cardiovascular system may aggravate an undiagnosed disease, and they should be alert even in case of mild cardiac symptoms that may interfere with pregnancy complaints.


Assuntos
Complicações Cardiovasculares na Gravidez/epidemiologia , Diagnóstico Pré-Natal , Adulto , Estudos Transversais , Ecocardiografia Transesofagiana , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/diagnóstico por imagem , Cardiopatias Congênitas/epidemiologia , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/epidemiologia , Turquia/epidemiologia , Saúde da Mulher
16.
Clin Exp Rheumatol ; 38(5): 1016-1020, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31969217

RESUMO

OBJECTIVES: The aim of the study is to evaluate the compliance rate to secondary prophylaxis and the presence of rheumatic heart disease (RHD) in a cohort of Italian patients with acute rheumatic fever (ARF). METHODS: This is a multicentre retrospective study. The patients were divided into two groups by the presence or absence at last follow-up of RHD. Clinical features, ARF recurrences and the rate of compliance to secondary prophylaxis were evaluated. RESULTS: Two-hundred and ninety patients were enrolled (137 females; 153 males). Carditis at onset was present in 244 patients (84.7%). At the end of follow-up, 173 patients manifested RHD. Adherence to secondary prophylaxis was low in 26% of patients. The presence of RHD at follow-up was associated with the presence of carditis and its severity at onset (p=0.001), but it was not related to secondary prophylaxis adherence (p=NS). No association between prophylaxis adherence and ARF recurrence was found (p=NS) nor between ARF recurrence and RHD at the end of follow-up (p=NS). CONCLUSIONS: Poor adherence to secondary prophylaxis does not seem to be associated with increased risk of RHD in developed countries. Further studies are needed to confirm our data in a larger population.


Assuntos
Febre Reumática , Cardiopatia Reumática , Países Desenvolvidos , Feminino , Humanos , Itália/epidemiologia , Masculino , Estudos Retrospectivos , Febre Reumática/diagnóstico , Febre Reumática/epidemiologia , Febre Reumática/prevenção & controle , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/prevenção & controle
17.
Circ J ; 84(2): 262-268, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-31839653

RESUMO

BACKGROUND: Few studies with a large sample size have been performed to evaluate the incidence, risk factors and prognostic value of new-onset atrial fibrillation (AF) in patients with infective endocarditis (IE).Methods and Results:A total of 1,063 IE patients were included and 83 developed new AF. Compared with no-AF, the incidence of in-hospital death (6.0% vs. 22.9%, P<0.001) was higher in patients with new-onset AF. New-onset AF was independently associated with increased risk of in-hospital (adjusted odds ratio [OR]=3.92, P=0.001) and 1-year death (adjusted hazard ratio=2.91, P=0.001), while prior AF was not an independent factor. Kaplan-Meier curve analysis demonstrated new-onset AF mainly affected short-term death (180 days). Age (OR=1.04, P<0.001), rheumatic heart disease (OR=1.88, P=0.022), NYHA Class III or IV (OR=2.09, P=0.003), and left atrial diameter (LAD; OR=1.05, P=0.006) were independent risk factors for development of new AF. CONCLUSIONS: New-onset AF, not prior AF, was a prognostic factor in IE patients, which was mainly associated with increased risk of short-term death. Patients with concomitant rheumatic heart disease, poor cardiac function, and larger LAD had higher risk of developing new AF.


Assuntos
Fibrilação Atrial/epidemiologia , Endocardite/epidemiologia , Cardiopatia Reumática/epidemiologia , Adulto , Idoso , Fibrilação Atrial/diagnóstico , Fibrilação Atrial/mortalidade , Fibrilação Atrial/terapia , China/epidemiologia , Endocardite/diagnóstico , Endocardite/mortalidade , Endocardite/terapia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Cardiopatia Reumática/diagnóstico , Cardiopatia Reumática/mortalidade , Cardiopatia Reumática/terapia , Medição de Risco , Fatores de Risco , Fatores de Tempo
18.
Aust N Z J Obstet Gynaecol ; 60(2): 302-308, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31782139

RESUMO

This retrospective study assessed maternal and perinatal outcomes for women with rheumatic heart disease (RHD) admitted to the largest tertiary obstetric hospital in Western Australia from 2009 to 2016. Of 54 women identified, 75.9% were Indigenous, 59.3% lived in rural areas and 40.7% had severe RHD. Heart failure developed in 10% who gave birth. Indigenous women were younger, had higher gravidity (P = 0.0305), were more likely to receive secondary prophylaxis (P = 0.0041) and have sub-optimal antenatal clinic attendance (P = 0.0078). There were no maternal deaths and two perinatal deaths (4.0%), reflecting vigilance in the obstetric management of women with RHD in Western Australia.


Assuntos
Povos Indígenas/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Complicações Cardiovasculares na Gravidez/epidemiologia , Cardiopatia Reumática/epidemiologia , Adulto , Feminino , Maternidades , Humanos , Gravidez , Resultado da Gravidez , Estudos Retrospectivos , Centros de Atenção Terciária , Austrália Ocidental/epidemiologia
19.
Asian Cardiovasc Thorac Ann ; 28(7): 431-443, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31752500

RESUMO

Due to the prevalence of rheumatic heart disease in the developing world, mechanical heart valves in the younger patient population remain the prostheses of choice if repair is not feasible. Despite their durability, mechanical valves are burdened by coagulation and thromboembolism. Modern design tools can be utilized during the design process of mechanical valves, which allow a more systematic design approach and more detailed analysis of the blood flow through and around valves. These tools include computer-aided design, manufacturing, and engineering, such as computational fluid dynamics and finite element analysis, modern manufacturing techniques such as additive manufacturing, and sophisticated in-vitro and in-vivo tests. Following this systematic approach, a poppet valve was redesigned and the results demonstrate the benefits of the method. More organized flow patterns and fewer complex fluid structures were observed. The alternative trileaflet valve design has also been identified as a potential solution and, if a similar design approach is adopted, it could lead to the development of an improved mechanical heart valve in the future. It is imperative that researchers in developing countries continue their search for a mechanical heart valve with a reduced thromboembolic risk, requiring less or no anticoagulation.


Assuntos
Países em Desenvolvimento , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valvas Cardíacas/cirurgia , Desenho de Prótese , Cardiopatia Reumática/cirurgia , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Desenho Assistido por Computador , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/epidemiologia , Doenças das Valvas Cardíacas/fisiopatologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valvas Cardíacas/diagnóstico por imagem , Valvas Cardíacas/fisiopatologia , Hemodinâmica , Humanos , Modelos Cardiovasculares , Recuperação de Função Fisiológica , Cardiopatia Reumática/diagnóstico por imagem , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/fisiopatologia , Fatores de Risco , Tromboembolia/etiologia , Tromboembolia/prevenção & controle , Resultado do Tratamento
20.
Nat Rev Cardiol ; 17(3): 145-154, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31519994

RESUMO

Rheumatic heart disease (RHD) is a complication of group A streptococcal infection that results from a complex interaction between the genetic make-up of the host, the infection itself and several other environmental factors, largely reflecting poverty. RHD is estimated to affect 33.4 million people and results in 10.5 million disability-adjusted life-years lost globally. The disease has long been considered heritable but still little is known about the host genetic factors that increase or reduce the risk of developing RHD. In the 1980s and 1990s, several reports linked the disease to the human leukocyte antigen (HLA) locus on chromosome 6, followed in the 2000s by reports implicating additional candidate regions elsewhere in the genome. Subsequently, the search for susceptibility loci has been reinvigorated by the use of genome-wide association studies (GWAS) through which millions of variants can be tested for association in thousands of individuals. Early findings implicate not only HLA, particularly the HLA-DQA1 to HLA-DQB1 region, but also the immunoglobulin heavy chain locus, including the IGHV4-61 gene segment, on chromosome 14. In this Review, we assess the emerging role of GWAS in assessing RHD, outlining both the advantages and disadvantages of this approach. We also highlight the potential use of large-scale, publicly available data and the value of international collaboration to facilitate comprehensive studies that produce findings that have implications for clinical practice.


Assuntos
Loci Gênicos , Febre Reumática/genética , Cardiopatia Reumática/genética , Animais , Genes de Cadeia Pesada de Imunoglobulina , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Cadeias alfa de HLA-DQ/genética , Cadeias alfa de HLA-DQ/imunologia , Cadeias beta de HLA-DQ/genética , Cadeias beta de HLA-DQ/imunologia , Humanos , Fenótipo , Febre Reumática/epidemiologia , Febre Reumática/imunologia , Cardiopatia Reumática/epidemiologia , Cardiopatia Reumática/imunologia , Medição de Risco , Fatores de Risco
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