Table 1
Rheumatic heart disease stages (9).
| Stage A |
|---|
|
|
| Stage B |
|
|
|
| Stage C |
|
|
|
|
| Stage D |
|
[i] *At least one morphological abnormality required if ≤ 20 years; at least two abnormalities required if >20 years.
**The guidelines specify the presence of clinical complications including the need for surgical intervention constitutes Stage D RHD. In the Australian setting, surgery is an option for all those requiring it, and since this audit did not include information on clinical history, surgical events provided by the RHD register were used to indicate the presence of Stage D RHD in this cohort.
Figure 1
Patient inclusion and stratification process. Registry data identified individuals with RHD and ARF diagnoses. Echocardiographic images were reviewed to determine RHD stage at baseline and at follow-up.
Table 2
Summary of patient data, RHD severity, and lesion type at baseline.
| ARF n = 192 n (%)* | No ARF n = 100 n (%)* | P-value† | |
|---|---|---|---|
| Age at baseline (years; mean (sd)) | 11.4 (3.7) | 12.8 (3.9) | 0.002 |
| Female | 96 (50.0%) | 65 (65.0%) | 0.018 |
| RHD stages | 0.009 | ||
| Early RHD – Stage A | 55 (28.6%) | 12 (12.0%) | |
| Early RHD – Stage B | 73 (38.0%) | 50 (50.0%) | |
| Advanced RHD – Stage C | 55 (28.6%) | 31 (31.0%) | |
| Advanced RHD – Stage D | 9 (4.7%) | 7 (7.0%) | |
| Total early RHD | 128 (66.7%) | 62 (62.0%) | 0.440 |
| Total advanced RHD | 64 (33.3%) | 38 (38.0%) | |
| Lesion type | |||
| Pathological mitral regurgitation – all** | 169 (88.0%) | 88 (88.0%) | 0.996 |
| Pathological aortic regurgitation – all** | 85 (44.3%) | 39 (39%) | 0.387 |
| Isolated mitral regurgitation | 40 (20.8%) | 7 (7.0%) | 0.002 |
| Isolated aortic regurgitation | 17 (8.9%) | 6 (6.0%) | 0.495 |
| MR and AR (no abnormal morphology) | 10 (5.2%) | 3 (3.0%) | 0.553 |
| MR with abnormal morphology (+/– AV disease) | 117 (60.9%) | 76 (76.0%) | 0.010 |
| AR with abnormal morphology (+/– MV disease) | 33 (17.2%) | 20 (20.0%) | 0.554 |
| Any mitral stenosis | 4 (2.1%) | 3 (3.0%) | 0.694 |
| Any aortic stenosis | 0 (0%) | 1 (1.0%) | 0.343 |
[i] *Column percentage, unless otherwise specified. †Fisher test, unless otherwise specified.
**Includes pathological regurgitation in isolation and in combination with other valve lesions.
AV, aortic valve; ARF, acute rheumatic fever; AR, aortic regurgitation; MR, mitral regurgitation; MV, mitral valve; RHD, rheumatic heart disease, sd, standard deviation.
Figure 2
RHD stage at baseline echocardiogram stratified by the presence of ARF or no ARF.
Table 3
Summary of patient data RHD severity and lesion type at follow-up.
| ARF n = 156 n (%)* | No ARF n = 74 n (%)* | P-value† | |
|---|---|---|---|
| Age at follow-up (years; mean (sd))* | 15.4 (4.2) | 16.8 (4.9) | 0.031 |
| Female | 78 (50%) | 50 (67.6%) | 0.016 |
| SAP adherence % (median, IQR) n = 197 | 81 (66–88) | 82 (69–89) | 0.966 |
| RHD stages | 0.008 | ||
| Resolved RHD | 45 (28.8%) | 13 (17.6%) | |
| Early RHD – Stage A | 20 (12.8%) | 5 (7.1%) | |
| Early RHD – Stage B | 53 (34.0%) | 33 (44.6%) | |
| Advanced RHD – Stage C | 25 (16.0%) | 17 (23.0%) | |
| Advanced RHD – Stage D | 13 (8.3%) | 6 (8.1%) | |
| Total early RHD | 73 (46.8%) | 38 (51.4%) | 0.165 |
| Total advanced RHD | 38 (24.4%) | 23 (31.1%) | |
| Resolved RHD | 45 (28.8%) | 13 (17.6%) | |
| Lesion type (resolved RHD excluded) | n = 111 | n = 61 | |
| Pathological mitral regurgitation – all | 92 (82.9%) | 56 (91.8%) | 0.166 |
| Pathological aortic regurgitation – all | 43 (38.7%) | 16 (26.2%) | 0.131 |
| Isolated mitral regurgitation | 11 (9.9%) | 2 (3.3%) | 0.141 |
| Isolated aortic regurgitation | 9 (8.1%) | 3 (4.9%) | 0.542 |
| MR and AR (no abnormal morphology) | 0 (0%) | 1 (1.6%) | 0.355 |
| MR with abnormal morphology (+/– AV disease) | 80 (72.1%) | 53 (86.9%) | 0.036 |
| AR with abnormal morphology (+/– MV disease) | 26 (23.4%) | 10 (16.4%) | 0.330 |
| Any mitral stenosis | 9 (8.1%) | 3 (4.9%) | 0.542 |
| Any aortic stenosis | 0 (0%) | 0 (0%) | – |
[i] *Column percentage, unless otherwise specified. †Fisher test, unless otherwise specified.
AV, aortic valve; ARF, acute rheumatic fever; AR, aortic regurgitation; MR, mitral regurgitation; RHD, rheumatic heart disease, SAP, secondary antibiotic prophylaxis; sd, standard deviation.
Figure 3
RHD stages at follow-up stratified by ARF and noARF status at baseline.
Figure 4
Sankey diagram demonstrating changes in RHD stage between baseline and follow-up echocardiogram. 4A shows those with ARF at baseline. 4B shows those with noARF at baseline. The width of each ribbon demonstrates the relative proportion of individuals in each stage at baseline and at follow-up.
Figure 5
Progression/regression of RHD stage from baseline to end of follow-up period stratified by ARF status.