Transition of pattern of Valvular Involvement in RHD after Rising Trend of Using Screening Echocardiography

Abstract

Background: Worldwide rheumatic heart disease (RHD) is the most common cause of heart disease with multi valvular pattern. Hospital or autopsy based studies related to valvular patterns in RHD over represents severe symptomatic cases. Over last few years, screening echocardiography has emerged as an important tool for diagnosis of asymptomatic RHD.Objective: To estimate the true prevalence of different patterns of valvular involvement across whole clinical spectrum (asymptomatic and symptomatic phase) of RHD.Methods: New patients attending cardiology OPD for cardiac evaluation for the presence of suspected heart disease were evaluated by screening echocardiography. Based on World Heart Federation (WHF) echocardiographic criteria 2012, total 3656 patients diagnosed to have RHD, out of which 1877(51.3%) patients were asymptomatic and rest 1779(48.6%) patients were symptomatic. Frequency of different valvular patterns were analysed in each group and also in total cases of RHD.Result: Majority of patterns were mixed type. Out of total cases RHD, MR +AR or isolated MR were the common patterns observed in 20.5%, 19.5% cases respectively. Among the asymptomatic group, mild MR, mild to moderate MR + mild AR were the common patterns observed in 35.4%, 32.4% cases respectively. Among the symptomatic group, severe MS most commonly observed in 55% cases.Conclusion: MR or MR + AR with mild to moderate intensity were the most common pattern observed in asymptomatic cases of RHD . As the burden of asymptomatic cases is high among total cases of RHD, therefore such patterns also reflected across whole clinical spectrum of RHD. Whereas patterns like severe MS (mixed / isolated ) were observed most commonly observed in symptomatic cases of RHD.