- Email: [email protected]
Natural history of borderline rheumatic heart disease in New Caledonia: a prospective cohort study
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Archives of Cardiovascular Diseases Supplements (2017) 9, 59-76
Methods 83 pregnant women with mitral valve stenosis followed-up from 2009 to 2012 and were prospectively evaluated. Results Women with mitral stenosis had significantly clinical high incidence of complications, deterioration of clinical status was observed (44, 57%, P<0,0001) congestive heart failure had observed (27, 71%, P<0,0001), hospitalization (32, 53%, P<0, 0001), need of cardiac medications (53, 75%, P<0, 0001), arrhythmias (16%, P<0, 05). And inexistent maternal mortality. New born outcome had in mitral stenosis an effect on fetal outcome. We had increasing preterm, delivery (17, 50%, P<0,01) reduced birth weight (20,48%, P<0,001), intrauterine growth retardation (12, 04%, P<0,01) babies hospitalizations (13, 25%, P<0,03). Increased maternal morbidity and unfavorable fetal outcome was seen mostly in patients with moderate and severe mitral stenosis. No death in newborn. Discussion Frequent maternal and fetal complications was observed in pregnant women with critical mitral stenosis, our patients beneficed beta blocker therapy and diuretic, no cardiac intervention and no percutaneous mitral balloon performed during pregnancy with advantage of no maternal or fetal mortality. Conclusion Pregnant with critical mitral stenosis form a high-risk groups of life • Threatening complications. • There is need for close maternal follow – up and fetal surveillance, and repair of mitral stenosis should be performed before pregnancy The authors hereby declare no conflict of interest
521 Echocardiographic parameters of heart failure in the patients with rheumatic mitral stenosis and arterial hypertension K. Kharbouche*, S. Benhaourech, J. Hassari, L. Azzouzi, R. Habbal CHU Ibn Rochd, Cardiologie, Casablanca, Maroc *Corresponding author: [email protected] Purpose The aim of the study is to compare the main ultrasound heart parameters in rheumatic mitral stenosis (RhMS) patients with/without arterial hypertension (AH). Methods This study included 54 patients (21 male and 33 female), aged: 47.3±4.1 years. All patients were divided into 2 groups: Group I included 25 patients with RhMS and without AH; group II consisted of 29 patients with RhMS and AH. Duration of AH anamnesis was 6.20±3.70 years. The control group consisted of 20 healthy people. Results The mean systolic/diastolic BP values were equal to 128±2/76±2 mmHg (1group) and 155±3/92±2mmHg (2 group) vs. 122±3/76±2mmHg in the control (p, 0.05). Planimetry of mitral valve area was lower than 2cm2 in both groups vs. 5.25±0,20cm2 in the control p, 0.05). Impaired response of myocardial function in hypertensive patients resulted to more significant difference in the peak velocity at early diastole (Ve, p, 0.01), atrial contraction (Va, p, 0.05), ratio Ve/Va (p, 0.01) between 1 and 2 group. Diameter of left atrial (LA), pressure gradient between LA and LV, pulmonary artery pressure, levels were equal to 4.43±0,18cm (1 group) and 5.46±0,19cm (2 group) vs. 3.54±0,12cm in the control (p, 0.05); 26.1±2,0mmHg and 32.1±2,1mmHg vs. 5.1±1,35mmHg (p, 0.05); 109.0±1,34mmHg and 114.5±1,12mmHg vs. 24.6±1,21mmHg (p, 0.05) respectively. HF functional NYHA class II-III was diagnosed in 24% (1 group) and 76% (2 group). Conclusions The study confirms the relationship between the severity of mitral valve alterations and diastolic dysfunction in patients with RhMS and AH. The authors hereby declare no conflict of interest
January 14th, Saturday 2017
087 Natural history of borderline rheumatic heart disease in New Caledonia: a prospective cohort study G. Bertaina* (1), B. Rouchon (2), B. Huon (2), N. Guillot (2), C. Robillard (2), B. Noel (2)-(3), M. Nadra (2)-(3), C. Tribouilloy (4), E. Marijon (1)(5), X. Jouven (1)-(5), M. Mirabel (1) (1) APHP-Hôpital Européen Georges Pompidou (HEGP), Cardiologie, INSERM U970 PARCC, Paris, France – (2) Agence Sanitaire et Sociale de Nouvelle-Calédonie, Nouméa, Nouvelle-Calédonie – (3) Centre Hospitalier Territorial, Nouméa, Nouvelle-Calédonie – (4) CHU Amiens, Amiens, France – (5) APHP-Hôpital Européen Georges Pompidou (HEGP), Paris, France *Corresponding author: [email protected] Background and Purpose The advent of systematic screening for rheumatic heart disease (RHD) by echocardiography in endemic regions has led to a new entity: borderline RHD. The pathogenicity and natural history of borderline RHD is to be addressed. The aim of this study was to assess the outcomes of children detected by echocardiography as having borderline RHD. Methods Schoolchildren in 4th grade (i.e., aged 9–10 years) who were prospectively screened for RHD (2012-2014) in Nouméa, New Caledonia, were asked to participate. Children with borderline RHD according to consistent independent review by two cardiologists were included and followed-up in 2015. Results Among the 8684 schoolchildren screened, 49 (5.6 per 1,000) were diagnosed with borderline RHD according to the Cardiologist clinically involved in the child's management plan. After independent review by two cardiologists, 25 children were consistently diagnosed with borderline RHD and included in the follow-up study. The inter-observer agreement was fair with diagnostic kappa values of 0.63 (95% CI 0.45-0.78). After a median follow-up of 23 months (IQR (20.5 - 33.0), 15 children (60.0%) had stability valvular lesions, 8 (32.0%) had normal findings according to the WHF criteria. Two children (8.0%) had definite RHD on the follow-up echocardiogram, but no clinical events or audible pathological murmur during the study period. No factor could be identified as prognostic of stability or progression. Conclusions Borderline RHD diagnosed by systematic screening in highrisk populations remains mostly unchanged at 2 years follow-up. Diagnosis of borderline RHD may however require two reviewers for consistency. Keywords Borderline Rheumatic Heart Disease; Heart Valve Disease; Ultrasounds; Global Health. The authors hereby declare no conflict of interest
262 The new epidemiological model for rheumatic heart disease: from subclinical to symptomatic disease M. Mirabel*(3)(4), M. Tafflet (4), B. Noel (2), C. Braunstein (2), M. Nadra (2), B. Rouchon (1), E. Marijon (3)-(4), X. Jouven (3)(4) (1) Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, NouvelleCalédonie – (2) Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie – (3) APHP-Hôpital Européen Georges Pompidou (HEGP), Paris, France – (4) APHP-Hôpital Européen Georges Pompidou (HEGP), Inserm U970, Paris, France *Corresponding author: [email protected] Background The advent of echocardiographic screening in endemic areas for rheumatic heart disease (RHD) has led to a new epidemiological pyramidtype model combining asymptomatic subclinical RHD at the base and severe RHD leading to hospital admission at the top. The aim is to provide population and hospital-based epidemiological data to support this hypothesis. Methods Two independent contemporary (2008-2011) studies were conducted assessing prevalence of subclinical RHD in schoolchildren by means of systematic
© Elsevier Masson SAS. All rights reserved.
Archives of Cardiovascular Diseases Supplements (2017) 9, 59-76
Methods 83 pregnant women with mitral valve stenosis followed-up from 2009 to 2012 and were prospectively evaluated. Results Women with mitral stenosis had significantly clinical high incidence of complications, deterioration of clinical status was observed (44, 57%, P<0,0001) congestive heart failure had observed (27, 71%, P<0,0001), hospitalization (32, 53%, P<0, 0001), need of cardiac medications (53, 75%, P<0, 0001), arrhythmias (16%, P<0, 05). And inexistent maternal mortality. New born outcome had in mitral stenosis an effect on fetal outcome. We had increasing preterm, delivery (17, 50%, P<0,01) reduced birth weight (20,48%, P<0,001), intrauterine growth retardation (12, 04%, P<0,01) babies hospitalizations (13, 25%, P<0,03). Increased maternal morbidity and unfavorable fetal outcome was seen mostly in patients with moderate and severe mitral stenosis. No death in newborn. Discussion Frequent maternal and fetal complications was observed in pregnant women with critical mitral stenosis, our patients beneficed beta blocker therapy and diuretic, no cardiac intervention and no percutaneous mitral balloon performed during pregnancy with advantage of no maternal or fetal mortality. Conclusion Pregnant with critical mitral stenosis form a high-risk groups of life • Threatening complications. • There is need for close maternal follow – up and fetal surveillance, and repair of mitral stenosis should be performed before pregnancy The authors hereby declare no conflict of interest
521 Echocardiographic parameters of heart failure in the patients with rheumatic mitral stenosis and arterial hypertension K. Kharbouche*, S. Benhaourech, J. Hassari, L. Azzouzi, R. Habbal CHU Ibn Rochd, Cardiologie, Casablanca, Maroc *Corresponding author: [email protected] Purpose The aim of the study is to compare the main ultrasound heart parameters in rheumatic mitral stenosis (RhMS) patients with/without arterial hypertension (AH). Methods This study included 54 patients (21 male and 33 female), aged: 47.3±4.1 years. All patients were divided into 2 groups: Group I included 25 patients with RhMS and without AH; group II consisted of 29 patients with RhMS and AH. Duration of AH anamnesis was 6.20±3.70 years. The control group consisted of 20 healthy people. Results The mean systolic/diastolic BP values were equal to 128±2/76±2 mmHg (1group) and 155±3/92±2mmHg (2 group) vs. 122±3/76±2mmHg in the control (p, 0.05). Planimetry of mitral valve area was lower than 2cm2 in both groups vs. 5.25±0,20cm2 in the control p, 0.05). Impaired response of myocardial function in hypertensive patients resulted to more significant difference in the peak velocity at early diastole (Ve, p, 0.01), atrial contraction (Va, p, 0.05), ratio Ve/Va (p, 0.01) between 1 and 2 group. Diameter of left atrial (LA), pressure gradient between LA and LV, pulmonary artery pressure, levels were equal to 4.43±0,18cm (1 group) and 5.46±0,19cm (2 group) vs. 3.54±0,12cm in the control (p, 0.05); 26.1±2,0mmHg and 32.1±2,1mmHg vs. 5.1±1,35mmHg (p, 0.05); 109.0±1,34mmHg and 114.5±1,12mmHg vs. 24.6±1,21mmHg (p, 0.05) respectively. HF functional NYHA class II-III was diagnosed in 24% (1 group) and 76% (2 group). Conclusions The study confirms the relationship between the severity of mitral valve alterations and diastolic dysfunction in patients with RhMS and AH. The authors hereby declare no conflict of interest
January 14th, Saturday 2017
087 Natural history of borderline rheumatic heart disease in New Caledonia: a prospective cohort study G. Bertaina* (1), B. Rouchon (2), B. Huon (2), N. Guillot (2), C. Robillard (2), B. Noel (2)-(3), M. Nadra (2)-(3), C. Tribouilloy (4), E. Marijon (1)(5), X. Jouven (1)-(5), M. Mirabel (1) (1) APHP-Hôpital Européen Georges Pompidou (HEGP), Cardiologie, INSERM U970 PARCC, Paris, France – (2) Agence Sanitaire et Sociale de Nouvelle-Calédonie, Nouméa, Nouvelle-Calédonie – (3) Centre Hospitalier Territorial, Nouméa, Nouvelle-Calédonie – (4) CHU Amiens, Amiens, France – (5) APHP-Hôpital Européen Georges Pompidou (HEGP), Paris, France *Corresponding author: [email protected] Background and Purpose The advent of systematic screening for rheumatic heart disease (RHD) by echocardiography in endemic regions has led to a new entity: borderline RHD. The pathogenicity and natural history of borderline RHD is to be addressed. The aim of this study was to assess the outcomes of children detected by echocardiography as having borderline RHD. Methods Schoolchildren in 4th grade (i.e., aged 9–10 years) who were prospectively screened for RHD (2012-2014) in Nouméa, New Caledonia, were asked to participate. Children with borderline RHD according to consistent independent review by two cardiologists were included and followed-up in 2015. Results Among the 8684 schoolchildren screened, 49 (5.6 per 1,000) were diagnosed with borderline RHD according to the Cardiologist clinically involved in the child's management plan. After independent review by two cardiologists, 25 children were consistently diagnosed with borderline RHD and included in the follow-up study. The inter-observer agreement was fair with diagnostic kappa values of 0.63 (95% CI 0.45-0.78). After a median follow-up of 23 months (IQR (20.5 - 33.0), 15 children (60.0%) had stability valvular lesions, 8 (32.0%) had normal findings according to the WHF criteria. Two children (8.0%) had definite RHD on the follow-up echocardiogram, but no clinical events or audible pathological murmur during the study period. No factor could be identified as prognostic of stability or progression. Conclusions Borderline RHD diagnosed by systematic screening in highrisk populations remains mostly unchanged at 2 years follow-up. Diagnosis of borderline RHD may however require two reviewers for consistency. Keywords Borderline Rheumatic Heart Disease; Heart Valve Disease; Ultrasounds; Global Health. The authors hereby declare no conflict of interest
262 The new epidemiological model for rheumatic heart disease: from subclinical to symptomatic disease M. Mirabel*(3)(4), M. Tafflet (4), B. Noel (2), C. Braunstein (2), M. Nadra (2), B. Rouchon (1), E. Marijon (3)-(4), X. Jouven (3)(4) (1) Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, NouvelleCalédonie – (2) Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie – (3) APHP-Hôpital Européen Georges Pompidou (HEGP), Paris, France – (4) APHP-Hôpital Européen Georges Pompidou (HEGP), Inserm U970, Paris, France *Corresponding author: [email protected] Background The advent of echocardiographic screening in endemic areas for rheumatic heart disease (RHD) has led to a new epidemiological pyramidtype model combining asymptomatic subclinical RHD at the base and severe RHD leading to hospital admission at the top. The aim is to provide population and hospital-based epidemiological data to support this hypothesis. Methods Two independent contemporary (2008-2011) studies were conducted assessing prevalence of subclinical RHD in schoolchildren by means of systematic
© Elsevier Masson SAS. All rights reserved.