Anurag Mehta1, Anita Saxena2, Rajnish Juneja3, Sivasubramanian Ramakrishnan3, Saurabh Gupta3, Shyam Sundar Kothari3. 1. Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. 2. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India. Electronic address: anitasaxena@hotmail.com. 3. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Abstract
BACKGROUND: Rheumatic heart disease (RHD) causes significant morbidity among children of low and middle-income countries. We aimed to assess characteristics and outcomes of Indian children enrolled in a tertiary care hospital RHD registry. METHODS: Pediatric patients (≤18years) were prospectively enrolled over three years. We evaluated their clinical and echocardiographic characteristics, valvular interventions, adherence to penicillin prophylaxis, and mortality. RESULTS: 451 patients were enrolled in the registry (mean age 12.2±3.2years, 34% females). Females had greater burden of exercise intolerance than males (26.8% NYHA classes III-IV versus [vs] 13.8%, p<0.01). Among 388 patients with no prior interventions, mitral regurgitation was the most common lesion (48.7%). 279 patients (71.9%) had severe valvular disease and this proportion was higher in females than males (80.9% vs. 67.6%, p<0.01). 248 patients received AHA/ACC class I recommendation for valvular interventions and 53 (21.4%) underwent an intervention during 11month (median) follow-up. Age (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 1.03-1.36), NYHA classes III-IV (aOR 4.96, 95% CI 2.51-9.60), mitral stenosis (aOR 37.01, 95% CI 6.96-196.74), and mixed mitral valve disease (aOR 2.79, 95% CI 1.03-7.56) were predictive of undergoing an intervention. Mean adherence to penicillin prophylaxis among 274 patients with clinic follow-up was 93.6%. 14 patients (3.1%) died during follow-up. CONCLUSIONS: Females had greater disease severity in an Indian pediatric RHD registry. Adherence to penicillin prophylaxis in the cohort was good. After 11months follow-up, one in five patients underwent a guideline-recommended intervention. Mortality was high during this short follow-up period.
BACKGROUND:Rheumatic heart disease (RHD) causes significant morbidity among children of low and middle-income countries. We aimed to assess characteristics and outcomes of Indian children enrolled in a tertiary care hospital RHD registry. METHODS: Pediatric patients (≤18years) were prospectively enrolled over three years. We evaluated their clinical and echocardiographic characteristics, valvular interventions, adherence to penicillin prophylaxis, and mortality. RESULTS: 451 patients were enrolled in the registry (mean age 12.2±3.2years, 34% females). Females had greater burden of exercise intolerance than males (26.8% NYHA classes III-IV versus [vs] 13.8%, p<0.01). Among 388 patients with no prior interventions, mitral regurgitation was the most common lesion (48.7%). 279 patients (71.9%) had severe valvular disease and this proportion was higher in females than males (80.9% vs. 67.6%, p<0.01). 248 patients received AHA/ACC class I recommendation for valvular interventions and 53 (21.4%) underwent an intervention during 11month (median) follow-up. Age (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 1.03-1.36), NYHA classes III-IV (aOR 4.96, 95% CI 2.51-9.60), mitral stenosis (aOR 37.01, 95% CI 6.96-196.74), and mixed mitral valve disease (aOR 2.79, 95% CI 1.03-7.56) were predictive of undergoing an intervention. Mean adherence to penicillin prophylaxis among 274 patients with clinic follow-up was 93.6%. 14 patients (3.1%) died during follow-up. CONCLUSIONS: Females had greater disease severity in an Indian pediatric RHD registry. Adherence to penicillin prophylaxis in the cohort was good. After 11months follow-up, one in five patients underwent a guideline-recommended intervention. Mortality was high during this short follow-up period.
Authors: Santanu Guha; S Harikrishnan; Saumitra Ray; Rishi Sethi; S Ramakrishnan; Suvro Banerjee; V K Bahl; K C Goswami; Amal Kumar Banerjee; S Shanmugasundaram; P G Kerkar; Sandeep Seth; Rakesh Yadav; Aditya Kapoor; Ajaykumar U Mahajan; P P Mohanan; Sundeep Mishra; P K Deb; C Narasimhan; A K Pancholia; Ajay Sinha; Akshyaya Pradhan; R Alagesan; Ambuj Roy; Amit Vora; Anita Saxena; Arup Dasbiswas; B C Srinivas; B P Chattopadhyay; B P Singh; J Balachandar; K R Balakrishnan; Brian Pinto; C N Manjunath; Charan P Lanjewar; Dharmendra Jain; Dipak Sarma; G Justin Paul; Geevar A Zachariah; H K Chopra; I B Vijayalakshmi; J A Tharakan; J J Dalal; J P S Sawhney; Jayanta Saha; Johann Christopher; K K Talwar; K Sarat Chandra; K Venugopal; Kajal Ganguly; M S Hiremath; Milind Hot; Mrinal Kanti Das; Neil Bardolui; Niteen V Deshpande; O P Yadava; Prashant Bhardwaj; Pravesh Vishwakarma; Rajeeve Kumar Rajput; Rakesh Gupta; S Somasundaram; S N Routray; S S Iyengar; G Sanjay; Satyendra Tewari; Sengottuvelu G; Soumitra Kumar; Soura Mookerjee; Tiny Nair; Trinath Mishra; U C Samal; U Kaul; V K Chopra; V S Narain; Vimal Raj; Yash Lokhandwala Journal: Indian Heart J Date: 2018-06-08