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Jonathan R Carapetis - One of the best experts on this subject based on the ideXlab platform.
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the high prevalence and impact of Rheumatic Heart Disease in pregnancy in first nations populations in a high income setting a prospective cohort study
British Journal of Obstetrics and Gynaecology, 2020Co-Authors: Jonathan R Carapetis, Warren F Walsh, Elizabeth A Sullivan, Geraldine Vaughan, Michael J Peek, Jane Frawley, Marc Remond, Bo RemenyiAbstract:Objective To describe the epidemiology of Rheumatic Heart Disease (RHD) in pregnancy in Australia and New Zealand (A&NZ). Design Prospective population-based study. Setting Hospital-based maternity units throughout A&NZ. Population Pregnant women with RHD with a birth outcome of ≥20 weeks of gestation between January 2013 and December 2014. Methods We identified eligible women using the Australasian Maternity Outcomes Surveillance System (AMOSS). De-identified antenatal, perinatal and postnatal data were collected and analysed. Main outcome measures Prevalence of RHD in pregnancy. Perinatal morbidity and mortality. Results There were 311 pregnancies associated with women with RHD (4.3/10 000 women giving birth, 95% CI 3.9-4.8). In Australia, 78% were Aboriginal or Torres Strait Islander (60.4/10 000, 95% CI 50.7-70.0), while in New Zealand 90% were Māori or Pasifika (27.2/10 000, 95% CI 22.0-32.3). One woman (0.3%) died and one in ten was admitted to coronary or intensive care units postpartum. There were 314 births with seven stillbirths (22.3/1000 births) and two neonatal deaths (6.5/1000 births). Sixty-six (21%) live-born babies were preterm and one in three was admitted to neonatal intensive care or special care units. Conclusion Rheumatic Heart Disease in pregnancy persists in disadvantaged First Nations populations in A&NZ. It is associated with significant cardiac and perinatal morbidity. Preconception planning and counselling and RHD screening in at-risk pregnant women are essential for good maternal and baby outcomes. Tweetable abstract Rheumatic Heart Disease in pregnancy persists in First Nations people in Australia and New Zealand and is associated with major cardiac and perinatal morbidity.
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how many doses make a difference an analysis of secondary prevention of Rheumatic fever and Rheumatic Heart Disease
Journal of the American Heart Association, 2018Co-Authors: Jessica L De Dassel, Jonathan R Carapetis, Nicholas De Klerk, Anna P RalphAbstract:Background Acute Rheumatic fever ( ARF ) and Rheumatic Heart Disease cause substantial burdens worldwide. Long-term antibiotic secondary prophylaxis is used to prevent Disease progression, but evidence for benefits of different adherence levels is limited. Using data from northern Australia, we identified factors associated with adherence, and the association between adherence and ARF recurrence, progression to Rheumatic Heart Disease, worsening or improvement of Rheumatic Heart Disease, and mortality. Methods and Results Factors associated with adherence (percent of doses administered) were analyzed using logistic regression. Nested case-control and case-crossover designs were used to investigate associations with clinical outcomes; conditional logistic regression was used to estimate odds ratios ( OR ) with 95% CIs Adherence estimates (7728) were analyzed. Being female, younger, having more-severe Disease, and living remotely were associated with higher adherence. Alcohol misuse was associated with lower adherence. The risk of ARF recurrence did not decrease until ≈40% of doses had been administered. Receiving <80% was associated with a 4-fold increase in the odds of ARF recurrence (case-control OR : 4.00 [95% CI : 1.7-9.29], case-crossover OR : 3.31 [95% CI : 1.09-10.07]) and appeared to be associated with increased all-cause mortality (case-control OR : 1.90 [95% CI : 0.89-4.06]; case-crossover OR 1.91 [95% CI : 0.51-7.12]). Conclusions We show for the first time that increased adherence to penicillin prophylaxis is associated with reduced ARF recurrence, and a likely reduction in mortality, in our setting. These findings can motivate patients to receive doses since even relatively low adherence can be beneficial, and additional doses further reduce adverse clinical outcomes.
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long term outcomes from acute Rheumatic fever and Rheumatic Heart Disease a data linkage and survival analysis approach
Circulation, 2016Co-Authors: John R Condon, Bart J. Currie, Anna P Ralph, Yuejen Zhao, Kathryn Roberts, Jessica L De Dassel, Marea Fittock, Keith Edwards, Jonathan R CarapetisAbstract:Background:We investigated adverse outcomes for people with acute Rheumatic fever (ARF) and Rheumatic Heart Disease (RHD) and the effect of comorbidities and demographic factors on these outcomes. ...
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acute Rheumatic fever and Rheumatic Heart Disease
Nature Reviews Disease Primers, 2016Co-Authors: Jonathan R Carapetis, Bongani M Mayosi, Ganesan Karthikeyan, Luiza Guilherme, Madeleine W. Cunningham, Craig Sable, Andrea Beaton, Andrew C SteerAbstract:Acute Rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF, which can result from a single severe episode or from multiple recurrent episodes of the illness, is known as Rheumatic Heart Disease (RHD) and is a notable cause of morbidity and mortality in resource-poor settings around the world. Although our understanding of Disease pathogenesis has advanced in recent years, this has not led to dramatic improvements in diagnostic approaches, which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed, penicillin has been the mainstay of treatment for decades and there is no other treatment that has been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent advances - including the use of echocardiographic diagnosis in those with ARF and in screening for early detection of RHD, progress in developing group A streptococcal vaccines and an increased focus on the lived experience of those with RHD and the need to improve quality of life - give cause for optimism that progress will be made in coming years against this neglected Disease that affects populations around the world, but is a particular issue for those living in poverty.
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Myositis complicating benzathine penicillin-G injection in a case of Rheumatic Heart Disease.
IDCases, 2016Co-Authors: Joshua R. Francis, Rosemary Wyber, Bo Remenyi, David Croser, Jonathan R CarapetisAbstract:A 7-year old boy developed myositis secondary to intramuscular injection of benzathine penicillin-G in the context of secondary prophylaxis for Rheumatic Heart Disease. Side effects of intramuscular delivery of benzathine penicillin-G are well described and include injection site pain and inflammation, but myositis, as depicted on magnetic resonance imaging in this case, has not previously been described.
Liesl Zuhlke - One of the best experts on this subject based on the ideXlab platform.
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Acute Rheumatic Fever and Rheumatic Heart Disease
Heart Valve Disease, 2020Co-Authors: G. Itzikowitz, E. A. Prendergast, B D Prendergast, Liesl ZuhlkeAbstract:Despite economic and medical advances, acute Rheumatic fever and consequent Rheumatic Heart Disease remain a major public health burden in low and middle-income countries, and a designated priority for the World Health Organisation. The clinical consequences are major and enduring, particularly for women of child-bearing age, and access to diagnosis, preventive therapy and transcatheter or surgical interventions remains a challenge. Herein, we provide a summary of key aspects of the condition, with particular focus on epidemiology, pathogenesis and immune mechanisms, diagnosis and clinical manifestations, contemporary management and preventive strategies.
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clinical outcomes in 3343 children and adults with Rheumatic Heart Disease from 14 low and middle income countries two year follow up of the global Rheumatic Heart Disease registry the remedy study
Circulation, 2016Co-Authors: Liesl Zuhlke, Ganesan Karthikeyan, Mark E Engel, Sumathy Rangarajan, Pam Mackie, Shofiqul Islam, Rezeen Daniels, Blanche Cupidokatya Mauff, Veronica Francis, S W O OgendoAbstract:Background: There are few contemporary data on the mortality and morbidity associated with Rheumatic Heart Disease or information on their predictors. We report the 2-year follow-up of individuals with Rheumatic Heart Disease from 14 low- and middle-income countries in Africa and Asia. Methods: Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive Heart failure, stroke or transient ischemic attack, recurrent acute Rheumatic fever, and infective endocarditis. Results: Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18–40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve Disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80–3.11), congestive Heart failure (HR, 2.16; 95% CI, 1.70–2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32–2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10–1.78), and older age (HR, 1.02; 95% CI, 1.01–1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54–0.85) and female sex (HR, 0.65; 95% CI, 0.52–0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive Heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute Rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle–income countries had significantly higher age- and sex-adjusted mortality than patients from upper-middle–income countries. Valve surgery was significantly more common in upper-middle–income than in lower-middle– or low-income countries. Conclusions: Patients with clinical Rheumatic Heart Disease have high mortality and morbidity despite being young; those from low- and lower-middle–income countries had a poorer prognosis associated with advanced Disease and low education. Programs focused on early detection and the treatment of clinical Rheumatic Heart Disease are required to improve outcomes. # Clinical Perspective {#article-title-38}
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evaluation of a focussed protocol for hand held echocardiography and computer assisted auscultation in detecting latent Rheumatic Heart Disease in scholars
Cardiology in The Young, 2016Co-Authors: Liesl Zuhlke, Mark E Engel, Simpiwe Nkepu, Bongani M MayosiAbstract:Introduction Echocardiography is the diagnostic test of choice for latent Rheumatic Heart Disease. The utility of echocardiography for large-scale screening is limited by high cost, complex diagnostic protocols, and time to acquire multiple images. We evaluated the performance of a brief hand-held echocardiography protocol and computer-assisted auscultation in detecting latent Rheumatic Heart Disease with or without pathological murmur. Methods A total of 27 asymptomatic patients with latent Rheumatic Heart Disease based on the World Heart Federation criteria and 66 healthy controls were examined by standard cardiac auscultation to detect pathological murmur. Hand-held echocardiography using a focussed protocol that utilises one view – that is, the parasternal long-axis view – and one measurement – that is, mitral regurgitant jet – and a computer-assisted auscultation utilising an automated decision tool were performed on all patients. Results The sensitivity and specificity of computer-assisted auscultation in latent Rheumatic Heart Disease were 4% (95% CI 1.0–20.4%) and 93.7% (95% CI 84.5–98.3%), respectively. The sensitivity and specificity of the focussed hand-held echocardiography protocol for definite Rheumatic Heart Disease were 92.3% (95% CI 63.9–99.8%) and 100%, respectively. The test reliability of hand-held echocardiography was 98.7% for definite and 94.7% for borderline Disease, and the adjusted diagnostic odds ratios were 1041 and 263.9 for definite and borderline Disease, respectively. Conclusion Computer-assisted auscultation has extremely low sensitivity but high specificity for pathological murmur in latent Rheumatic Heart Disease. Focussed hand-held echocardiography has fair sensitivity but high specificity and diagnostic utility for definite or borderline Rheumatic Heart Disease in asymptomatic patients.
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characteristics complications and gaps in evidence based interventions in Rheumatic Heart Disease the global Rheumatic Heart Disease registry the remedy study
European Heart Journal, 2015Co-Authors: Liesl Zuhlke, Ganesan Karthikeyan, Mark E Engel, Sumathy Rangarajan, Pam Mackie, Blanche Cupido, Katya Mauff, Shofiqul Islam, Alexia Joachim, Rezeen DanielsAbstract:Aims Rheumatic Heart Disease (RHD) accounts for over a million premature deaths annually; however, there is little contemporary information on presentation, complications, and treatment. Methods and results This prospective registry enrolled 3343 patients (median age 28 years, 66.2% female) presenting with RHD at 25 hospitals in 12 African countries, India, and Yemen between January 2010 and November 2012. The majority (63.9%) had moderate-to-severe multivalvular Disease complicated by congestive Heart failure (33.4%), pulmonary hypertension (28.8%), atrial fibrillation (AF) (21.8%), stroke (7.1%), infective endocarditis (4%), and major bleeding (2.7%). One-quarter of adults and 5.3% of children had decreased left ventricular (LV) systolic function; 23% of adults and 14.1% of children had dilated LVs. Fifty-five percent ( n = 1761) of patients were on secondary antibiotic prophylaxis. Oral anti-coagulants were prescribed in 69.5% ( n = 946) of patients with mechanical valves ( n = 501), AF ( n = 397), and high-risk mitral stenosis in sinus rhythm ( n = 48). However, only 28.3% ( n = 269) had a therapeutic international normalized ratio. Among 1825 women of childbearing age (12–51 years), only 3.6% ( n = 65) were on contraception. The utilization of valvuloplasty and valve surgery was higher in upper-middle compared with lower-income countries. Conclusion Rheumatic Heart Disease patients were young, predominantly female, and had high prevalence of major cardiovascular complications. There is suboptimal utilization of secondary antibiotic prophylaxis, oral anti-coagulation, and contraception, and variations in the use of percutaneous and surgical interventions by country income level.
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the case for global investment in Rheumatic Heart Disease control
Bulletin of The World Health Organization, 2014Co-Authors: Rosemary Wyber, Liesl Zuhlke, Jonathan R CarapetisAbstract:Rheumatic Heart Disease comprises a small proportion of the total global Disease burden according to current estimates. A rare complication of a streptococcal throat infection, Rheumatic Heart Disease causes Heart valve damage and progressive Heart failure. The cause and course of this Disease can be difficult to explain to policy-makers and to people at risk. The relative burden and complexity of the Disease have contributed to its neglect by governments, donors and decision-makers. We argue that the World Health Organization (WHO) and national governments should rekindle their Rheumatic Heart Disease control programmes. Rheumatic Heart Disease is now unusual in most high-resource settings because of access to health care and availability of antibiotics. However, it remains endemic in socioeconomically vulnerable populations in high-income countries and in low- and middle-income country settings.1 Prevention and control measures for Rheumatic Heart Disease include reduction of household crowding, timely diagnosis and appropriate antibiotics for bacterial pharyngitis and – in people who develop Rheumatic fever – antibiotic prophylaxis over several years to prevent Disease progression. Global public health has no shortage of challenges such as improving sanitation, eradicating polio and preventing tobacco use. A utilitarian approach pervades attempts to deliver the best possible health care for the greatest number of people. Limited human, financial and logistical resources make prioritization essential. Funding and policy meetings are increasingly focused on identifying easily achievable and high impact global health interventions. However, only a fraction of global health needs are amenable to simple and scalable interventions. When and why should time, energy and money be invested in more complex problems? Reflecting on these uncertainties, we build the case for investing in global control of Rheumatic Heart Disease, with a focus on highly endemic settings.
Du Feng - One of the best experts on this subject based on the ideXlab platform.
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the cardiothoracic ratio a neglected preoperative risk stratified method for patients with Rheumatic Heart Disease undergoing valve replacement surgery
European Journal of Cardio-Thoracic Surgery, 2019Co-Authors: Wei Guo Chen, Qing-shan Geng, Gang Du, Pengcheng He, Du FengAbstract:OBJECTIVES: It is common for patients with Rheumatic Heart Disease to have an enlarged Heart. We investigated the prognostic value of cardiothoracic ratio (CTR) in patients with Rheumatic Heart Disease undergoing valve replacement surgery. METHODS: A total of 1772 patients were divided into 4 groups based on the quartiles of preoperative CTR: 0.6, which was significantly higher in males without a CTR. A similar result was observed in females (1.9 vs 5.1%, P = 0.004). Multivariable regression showed that a CTR >0.6 was an independent predictor of in-hospital (odds ratio 2.36, P = 0.005) and 1-year mortality (hazard ratio 2.06, P = 0.006). Kaplan-Meier curves, for the cumulative rate of 1-year mortality among groups, indicated that the risk of death was increased if the CTR >0.6 (log-rank 16.36, P < 0.001). CONCLUSIONS: CTR, as a simple and reproducible indicator, was identified as a prognostic factor for predicting poor outcomes in patients with Rheumatic Heart Disease undergoing valve replacement surgery.
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the cardiothoracic ratio a neglected preoperative risk stratified method for patients with Rheumatic Heart Disease undergoing valve replacement surgery
European Journal of Cardio-Thoracic Surgery, 2019Co-Authors: Lei Jiang, Qing-shan Geng, Wei Guo Chen, Du Feng, Tiehe Qin, Xuebiao WeiAbstract:Objectives It is common for patients with Rheumatic Heart Disease to have an enlarged Heart. We investigated the prognostic value of cardiothoracic ratio (CTR) in patients with Rheumatic Heart Disease undergoing valve replacement surgery. Methods A total of 1772 patients were divided into 4 groups based on the quartiles of preoperative CTR: Results In-hospital mortality was 4.0% (71/1772). Analyses of receiver operating characteristic curves showed that, at a cut-off of 0.6, the CTR exhibited 66.2% sensitivity and 64.0% specificity for detecting in-hospital death (area under curve 0.671, P 0.6, which was significantly higher in males without a CTR. A similar result was observed in females (1.9 vs 5.1%, P = 0.004). Multivariable regression showed that a CTR >0.6 was an independent predictor of in-hospital (odds ratio 2.36, P = 0.005) and 1-year mortality (hazard ratio 2.06, P = 0.006). Kaplan-Meier curves, for the cumulative rate of 1-year mortality among groups, indicated that the risk of death was increased if the CTR >0.6 (log-rank 16.36, P Conclusions CTR, as a simple and reproducible indicator, was identified as a prognostic factor for predicting poor outcomes in patients with Rheumatic Heart Disease undergoing valve replacement surgery.
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serum uric acid as a simple risk factor in patients with Rheumatic Heart Disease undergoing valve replacement surgery
Clinica Chimica Acta, 2017Co-Authors: Xuebiao Wei, Du Feng, Lei Jiang, Yuanhui Liu, Jiyan Chen, Ning TanAbstract:Abstract Background We evaluated the relationship between admission serum uric acid (SUA) and in-hospital and one-year mortality after valve replacement surgery (VRS) for patients with Rheumatic Heart Disease (RHD). Methods One-thousand five-hundred thirty-six consecutive patients with RHD undergoing VRS were divided into 4 groups based on the quartiles of SUA on admission. The association between SUA and adverse outcomes was analyzed. Results The in-hospital mortality (2.1% vs 2.6% vs 5.3% vs 7.7%, p 7.3 mg/dl (Log-rank = 21.1, p Conclusions Admission SUA could be used as a preoperative risk assessment factor in RHD patients who underwent VRS.
Andrew C Steer - One of the best experts on this subject based on the ideXlab platform.
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acute Rheumatic fever and Rheumatic Heart Disease
Nature Reviews Disease Primers, 2016Co-Authors: Jonathan R Carapetis, Bongani M Mayosi, Ganesan Karthikeyan, Luiza Guilherme, Madeleine W. Cunningham, Craig Sable, Andrea Beaton, Andrew C SteerAbstract:Acute Rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF, which can result from a single severe episode or from multiple recurrent episodes of the illness, is known as Rheumatic Heart Disease (RHD) and is a notable cause of morbidity and mortality in resource-poor settings around the world. Although our understanding of Disease pathogenesis has advanced in recent years, this has not led to dramatic improvements in diagnostic approaches, which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed, penicillin has been the mainstay of treatment for decades and there is no other treatment that has been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent advances - including the use of echocardiographic diagnosis in those with ARF and in screening for early detection of RHD, progress in developing group A streptococcal vaccines and an increased focus on the lived experience of those with RHD and the need to improve quality of life - give cause for optimism that progress will be made in coming years against this neglected Disease that affects populations around the world, but is a particular issue for those living in poverty.
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estimates of the global burden of Rheumatic Heart Disease
Global heart, 2013Co-Authors: Liesl Zuhlke, Andrew C SteerAbstract:In this review, we make the case that currently available figures used to define the global burden of acute Rheumatic fever and Rheumatic Heart Disease, although crucial to control efforts, are imperfect. Data have been hindered by methodological differences between studies, by patchy coverage within countries and across regions, and by an incomplete understanding of the relationship between echocardiographic detection of asymptomatic mild Disease and progression to symptomatic Disease. We argue that in order to advocate effectively for patients with Rheumatic Heart Disease now and into the future, true burden of Disease estimates on local, national, and international levels are urgently required. We critically review previous burden of Disease estimates and outline the issues in defining the “true” burden of Rheumatic Heart Disease, and we propose a new model for Rheumatic Heart Disease epidemiologic studies. This is of particular relevance in 2012 with an ever-increasing burden of cardiovascular Disease globally.
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screening for Rheumatic Heart Disease current approaches and controversies
Nature Reviews Cardiology, 2013Co-Authors: Kathryn Roberts, Andrew C Steer, Bo Remenyi, Samantha M Colquhoun, Jonathan R CarapetisAbstract:Rheumatic Heart Disease (RHD) is a leading cause of cardiac Disease among children in developing nations, and in indigenous populations of some industrialized countries. In endemic areas, RHD has long been a target of screening programmes that, historically, have relied on cardiac auscultation. The evolution of portable echocardiographic equipment has changed the face of screening for RHD over the past 5 years, with greatly improved sensitivity. However, concerns have been raised about the specificity of echocardiography, and the interpretation of minor abnormalities poses new challenges. The natural history of RHD in children with subclinical abnormalities detected by echocardiographic screening remains unknown, and long-term follow-up studies are needed to evaluate the significance of detecting these changes at an early stage. For a Disease to be deemed suitable for screening from a public health perspective, it needs to fulfil a number of criteria. RHD meets some, but not all, of these criteria. If screening programmes are to identify additional cases of RHD, parallel improvements in the systems that deliver secondary prophylaxis are essential.
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streptococcal skin infection and Rheumatic Heart Disease
Current Opinion in Infectious Diseases, 2012Co-Authors: Tom Parks, Pierre R Smeesters, Andrew C SteerAbstract:In resource-limited tropical settings, both impetigo and Rheumatic Disease are endemic. The major cause of impetigo in these regions is the group A streptococcus and there is a growing body of opinion implicating impetigo in the pathogenesis of Rheumatic fever and Rheumatic Heart Disease (RHD). This potentially has major implications for control of these neglected Diseases, which account for at least 350 000 deaths worldwide, annually. In this review, we summarize recent advances in the epidemiology of group A streptococcal skin Disease and examine evidence for the relationship between group A streptococcal skin Disease and Rheumatic fever.
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acute Rheumatic fever and Rheumatic Heart Disease in indigenous populations
Pediatric Clinics of North America, 2009Co-Authors: Andrew C Steer, Jonathan R CarapetisAbstract:Acute Rheumatic fever and Rheumatic Heart Disease are Diseases of socioeconomic disadvantage. These Diseases are common in developing countries and in Indigenous populations in industrialized countries. Clinicians who work with Indigenous populations need to maintain a high index of suspicion for the potential diagnosis of acute Rheumatic fever, particularly in patients presenting with joint pain. Inexpensive medicines, such as aspirin, are the mainstay of symptomatic treatment of Rheumatic fever; however, antiinflammatory treatment has no effect on the long-term rate of progression or severity of chronic valvular Disease. The current focus of global efforts at prevention of Rheumatic Heart Disease is on secondary prevention (regular administration of penicillin to prevent recurrent Rheumatic fever), although primary prevention (timely treatment of streptococcal pharyngitis to prevent Rheumatic fever) is also important in populations in which it is feasible.
Xuebiao Wei - One of the best experts on this subject based on the ideXlab platform.
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the cardiothoracic ratio a neglected preoperative risk stratified method for patients with Rheumatic Heart Disease undergoing valve replacement surgery
European Journal of Cardio-Thoracic Surgery, 2019Co-Authors: Lei Jiang, Qing-shan Geng, Wei Guo Chen, Du Feng, Tiehe Qin, Xuebiao WeiAbstract:Objectives It is common for patients with Rheumatic Heart Disease to have an enlarged Heart. We investigated the prognostic value of cardiothoracic ratio (CTR) in patients with Rheumatic Heart Disease undergoing valve replacement surgery. Methods A total of 1772 patients were divided into 4 groups based on the quartiles of preoperative CTR: Results In-hospital mortality was 4.0% (71/1772). Analyses of receiver operating characteristic curves showed that, at a cut-off of 0.6, the CTR exhibited 66.2% sensitivity and 64.0% specificity for detecting in-hospital death (area under curve 0.671, P 0.6, which was significantly higher in males without a CTR. A similar result was observed in females (1.9 vs 5.1%, P = 0.004). Multivariable regression showed that a CTR >0.6 was an independent predictor of in-hospital (odds ratio 2.36, P = 0.005) and 1-year mortality (hazard ratio 2.06, P = 0.006). Kaplan-Meier curves, for the cumulative rate of 1-year mortality among groups, indicated that the risk of death was increased if the CTR >0.6 (log-rank 16.36, P Conclusions CTR, as a simple and reproducible indicator, was identified as a prognostic factor for predicting poor outcomes in patients with Rheumatic Heart Disease undergoing valve replacement surgery.
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serum uric acid as a simple risk factor in patients with Rheumatic Heart Disease undergoing valve replacement surgery
Clinica Chimica Acta, 2017Co-Authors: Xuebiao Wei, Du Feng, Lei Jiang, Yuanhui Liu, Jiyan Chen, Ning TanAbstract:Abstract Background We evaluated the relationship between admission serum uric acid (SUA) and in-hospital and one-year mortality after valve replacement surgery (VRS) for patients with Rheumatic Heart Disease (RHD). Methods One-thousand five-hundred thirty-six consecutive patients with RHD undergoing VRS were divided into 4 groups based on the quartiles of SUA on admission. The association between SUA and adverse outcomes was analyzed. Results The in-hospital mortality (2.1% vs 2.6% vs 5.3% vs 7.7%, p 7.3 mg/dl (Log-rank = 21.1, p Conclusions Admission SUA could be used as a preoperative risk assessment factor in RHD patients who underwent VRS.