Table 1
Baseline Characteristics, Clinical Manifestations, Diagnostic Details, And treatment Among Overall Patients, And compared Between those Who Did and Did Not Develop Recurrent ARF During Follow-Up.
| PATIENT CHARACTERISTICS | ALL PATIENTS (n = 81) | MITRAL VALVE REGRESSION DURING FOLLOW-UP (n = 46) | NO MITRAL VALVE REGRESSION DURING FOLLOW-UP (n = 35) | p-VALUE |
|---|---|---|---|---|
| Demographic/anthropometric data | ||||
| – Age at onset (years) | 10.5 ± 2.8 | 9.5 ± 2.5 | 10.6 ± 2.9 | 0.07 |
| – Male gender | 45 (55.6%) | 24 (52.2%) | 21 (60.0%) | 0.51 |
| – Weight (kg) | 30 (21.5, 43.2) | 29.2 (20.8, 39.9) | 31.8 (23.2, 51.5) | 0.20 |
| – Height (cm) | 136.9 ± 17.9 | 133.6 ± 17 | 141.4 ± 18.3 | 0.05 |
| – Body surface area (m2) | 1.1 ± 0.3 | 1.1 ± 0.3 | 1.2 ± 0.3 | 0.09 |
| Major manifestations | ||||
| – Migratory polyarthritis | 20 (24.7%) | 13 (28.3%) | 7 (20%) | 0.44 |
| – Sydenham chorea | 8 (9.9%) | 4 (8.7%) | 4 (11.4%) | 0.72 |
| – Subcutaneous nodule | 3 (3.7%) | 1 (2.2%) | 2 (5.7%) | 0.57 |
| Minor manifestations | ||||
| – Fever | 61 (75.3%) | 37 (80.4%) | 24 (68.6%) | 0.30 |
| – Arthralgia | 29 (35.8%) | 14 (30.4%) | 15 (42.9%) | 0.35 |
| – Elevated ESR/CRP | 75 (92.6%) | 45 (97.8%) | 30 (85.7%) | 0.08 |
| – Prolonged PR interval | 14 (17.3%) | 7 (15.2%) | 7 (20%) | 0.77 |
| – ESR (mm/hr) | 66 (42, 98) | 76.5 (51.5, 102.2) | 61 (32, 86) | 0.03 |
| – CRP (mg/L) | 35.5 (13, 84.5) | 29.7 (11.6, 82.2) | 50 (16.9, 84.5) | 0.39 |
| Evidence of a preceding GAS infection | ||||
| – Positive throat swab culture (n = 57) | 4 (7.0%) | 3 (9.4%) | 1 (4.0%) | 0.62 |
| – ASO titer (n = 78) | ||||
| – Positive | 76 (97.4%) | 43 (97.7%) | 33 (97.1%) | 1.00 |
| – Value (IU/ml) | 563 (355.5, 1090) | 567 (400, 1004.5) | 545 (310, 1220) | 0.98 |
| – Anti-DNaseB (n = 47) | ||||
| – Positive | 43 (91.5%) | 17 (81%) | 26 (100%) | 0.03 |
| – Value (U/ml) | 703 (402, 1089) | 653.5 (323, 1097.5) | 757.5 (435.7, 1089.2) | 0.55 |
| Treatment | ||||
| – Admission (days) | 33.64 ± 24.40 | 53.3 ± 79 | 37.7 ± 44.8 | 0.23 |
| – Bed rest (days) | 30 (28, 60) | 30 (28, 48.7) | 30 (14, 60) | 0.83 |
| – Prednisone administration | ||||
| – Patients | 66 (81.5%) | 38 (82.6%) | 28 (80%) | 0.78 |
| – Duration (months) | 1.3 (0.9, 2.2) | 1.3 (1, 1.9) | 1.3 (0.9, 2.4) | 0.88 |
| – Dose (mg/kg/day) | 2 (2, 2) | 2 (2, 2) | 2 (2, 2) | 0.90 |
| – Aspirin administration | ||||
| – Patients | 72 (88.9%) | 41 (50.6%) | 31 (38.3%) | 1.00 |
| – Duration (months) | 4.69 (2.6, 7.0) | 4.8 (2.7, 6.9) | 4.5 (2.4, 7) | 0.73 |
| – Dose (mg/kg/day) | 80 (75, 84.7) | 80 (75, 82) | 80 (75, 85) | 0.70 |
| – Compliance with ATB prophylaxis | 68 (84%) | 40 (87%) | 28 (80%) | 0.54 |
| Recurrent ARF | ||||
| – Recurrent ARF (n = 11) | 11 (13.6%) | 6 (13%) | 5 (14.3%) | 1.00 |
[i] Data presented as mean ± standard deviation, median and interquartile range, or number and percentage.
A p-value < 0.05 indicates statistical significance.
Abbreviations: anti-DNaseB, antideoxyribonuclease B; ARF, acute rheumatic fever; ASA, acetylsalicylic acid or aspirin; ASO titer, anti-streptolysin O titer; ATB, antibiotic drugs; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; GAS infection, group a streptococcal infection; Prolonged PR interval, delayed conduction between the atria and the ventricles.
Table 2
Echocardiographic findings at the initial onset of ARF among overall patients, and compared between those who did and did not develop recurrent ARF during follow-up.
| FINDINGS | ALL PATIENTS (n = 81) | MITRAL VALVE REGRESSION DURING FOLLOW-UP (n = 46) | NO MITRAL VALVE REGRESSION DURING FOLLOW-UP (n = 35) | p-VALUE |
|---|---|---|---|---|
| At presentation | ||||
| Presence with MR alone | 16 (19.8%) | 7 (20.0%) | 9 (19.6%) | 0.96 |
| Z-score-LVEDD | 2.32 (0.70, 3.27) | 2.91 (1.70, 3.65) | 2.12 (–0.02, 2.84) | 0.001 |
| Z-score-LVESD | 2.04 (0.78, 3.27) | 2.69 (1.67, 3.45) | 1.38 (0.19, 2.87) | 0.002 |
| LVEF (%) | 63.3 ± 6.7 | 62.6 ± 7.8 | 63.43 ± 6.6 | 0.74 |
| RVSP (mmHg) | 42.56 (29.3, 57.3) | 38 (32, 50) | 44 (28.7, 59) | 0.98 |
| Pericardial effusion (%) | 28 (34.6%) | 5 (45.4%) | 23 (32.9%) | 0.50 |
| At last follow up | ||||
| z-score-LVEDD | 0.74 (–0.39, 2.64) | 0.52 (–0.45, 1.93) | 1.27 (–0.12, 2.88) | 0.2 |
| z-score-LVESD | 0.87 (–0.13, 2.22) | 0.63 (–0.15, 1.78) | 1.18 (–0.12, 2.32) | 0.64 |
[i] Data presented as mean ± standard deviation, median and interquartile range, or number and percentage.
A p-value < 0.05 indicates statistical significance.
Definitions: ARF, acute rheumatic fever; LVEDD, left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; RVSP, right ventricular systolic pressure.
Figure 1
The incidence Of Mitral Regurgitation (MR) And/or Aortic Regurgitation (AR) At The Initial Onset of acute rheumatic fever (ARF) Stratified According To MR And AR Severity.
Figure 2
Kaplan-Meier Survival analysis Was used To Evaluate the Duration From (A) Moderate-Severe mitral regurgitation (mr) To Non-clinically significant (NCS) MR, And From (B) Moderate-Severe Aortic Regurgitation (AR) To NCS AR.
Table 3
Cox proportional univariate and multivariate analysis to identify factors independently associated with clinically significant MR regression.
| POTENTIAL PREDICTORS OF MITRAL VALVE REGRESSION | UNIVARIATE ANALYSIS | MULTIVARIATE ANALYSIS | ||
|---|---|---|---|---|
| HR (95%CI) | p* | AHR (95%CI) | p | |
| Age at presentation | 0.93 (0.83–1.04) | 0.218 | ||
| Female gender | 1.06 (0.59–1.91) | 0.842 | ||
| Domicile in capital city | 0.90 (0.47–1.72) | 0.747 | ||
| ESR level | 1.01 (1.00–1.02) | 0.007 | 1.01 (1.01 – 1.03) | 0.01 |
| CRP level | 1.00 (1.00–1.01) | 0.798 | ||
| Presented with heart failure | 1.35 (0.73–2.50) | 0.332 | ||
| Severe carditis at presentation | 5.83 (1.80–18.91) | 0.003 | 4.14 (1.02–16.86) | 0.05 |
| Administration of glucocorticoids | 0.99 (0.93–1.06) | 0.759 | ||
| Duration of prednisolone treatment | 0.99 (0.95–1.03) | 0.590 | ||
| Duration of ASA treatment | 1.00 (0.99–1.01) | 0.741 | ||
| Duration of bed rest | 1.00 (0.99–1.01) | 0.741 | ||
| Good compliance with ATB prophylaxis | 1.29 (0.54–3.04) | 0.566 | ||
| Presence with MR alone | 0.56 (0.26–1.20) | 0.136 | ||
| Z-score LVEDD at presentation | 1.39 (1.15 – 1.69) | 0.001 | 1.12 (0.87 – 1.46) | 0.381 |
| Z-score LVESD at presentation | 1.46 (1.16 – 1.83) | 0.001 | ||
| LVEF | 1.00 (0.95–1.06) | 0.919 | ||
| Z-score LVEDD at last follow up | 0.94 (0.80 – 1.10) | 0.426 | ||
| Z-score LVESD at last follow up | 0.97 (0.93 – 1.14) | 0.727 | ||
| History of recurrent ARF | 0.89 (0.38–2.11) | 0.793 | ||
[i] A p-value < 0.05 is considered statistically significant.
*Factors with a p-value < 0.20 from univariate logistic regression analysis were included in the multivariate analysis.
Abbreviations: aHR, adjusted hazard ratio; AR, aortic valve regurgitation; ASA, acetylsalicylic acid or aspirin; ATB, antibiotic drugs; CI, confidence interval; CRP, C-reactive protein; ESR, erythrocyte sedimentation rate; HR, hazard ratio; LVEDD, left ventricular end-diastolic diameter; LVEF, left ventricular ejection fraction; LVESD, left ventricular end-systolic diameter; MR, mitral valve regurgitation.