Doppler Echocardiographic Follow-Up of Mitral and Aortic Regurgitation in Children and Adolescents with Subclinical and Mild Rheumatic Carditis

Abstract Background: Mild rheumatic carditis (MRC) and subclinical rheumatic carditis (SRC) are basically differentiated through auscultation of mitral regurgitation murmur. The evolution of these forms is not well established in the literature. Objective: To evaluate the evolution of mild and subclinical rheumatic carditis, considering mitral and aortic regurgitation (acute phase) and regression, maintenance or worsening of these diseases at the end of follow-up (chronic phase). Methods: Retrospective, longitudinal study, including patients with mild and subclinical rheumatic carditis. The echocardiographic evolution of mitral and aortic regurgitation was compared in both groups, considering the analysis at the end of follow-up. The Chi-square test and Kaplan-Meier survival curves were used, with significance level established at p < 0.05. Results: A total of 125 patients were included, 69 (55.2%) with subclinical rheumatic carditis and 56 (44.8%) with mild rheumatic carditis, with a mean age in the acute phase of 10.4 ± 2.6 years and, at the end of study, 19.9 ± 4.6 years. The time of follow-up ranged from 2 to 23 years (mean: 9.38 ± 4.3 years). In the acute phase, mild/moderate or moderate mitral regurgitation was more frequent in patients with mild rheumatic carditis (p = 0.001). Mild or mild/moderate aortic regurgitation was also more common in the mild rheumatic carditis group (p = 0.045). In the chronic phase, we observed that both mitral (p < 0.0001) and aortic regurgitation (p = 0.009) were more frequent in patients with mild rheumatic carditis, and survival free of rheumatic heart disease was higher in the subclinical rheumatic carditis group (p = 0.010). Residual mitral regurgitation was higher in the mild rheumatic carditis group p < 0.0001), and residual aortic regurgitation was similar in both groups (p = 0.099). Conclusion: Mitral regurgitation resolution was higher in patients with subclinical rheumatic carditis, and the involution of aortic regurgitation was less frequent and similar in both groups. (Int J Cardiovasc Sci. 2017;30(5):391-400)

摘要 背景：轻度风湿性心脏病（mild rheumatic carditis, MRC）与亚临床风湿性心脏病（subclinical rheumatic carditis, SRC）主要通过听诊二尖瓣反流杂音进行鉴别。目前文献中对这两类疾病的转归尚未明确阐明。目的：评估轻度及亚临床风湿性心脏病的转归情况，以急性期二尖瓣反流与主动脉反流为观察指标，对比随访期末（慢性期）上述病变的消退、维持或进展情况。方法：本研究为回顾性纵向研究，纳入轻度与亚临床风湿性心脏病患者。以随访期末的分析结果为依据，对比两组患者二尖瓣反流与主动脉反流的超声心动图转归情况。采用卡方检验与Kaplan-Meier生存曲线进行统计分析，检验水准设定为p < 0.05。结果：本研究共纳入125例患者，其中69例（55.2%）为亚临床风湿性心脏病患者，56例（44.8%）为轻度风湿性心脏病患者。急性期患者平均年龄为10.4 ± 2.6岁，研究结束时平均年龄为19.9 ± 4.6岁。随访时长为2~23年，平均随访时长为9.38 ± 4.3年。急性期，轻度风湿性心脏病患者中轻中度或中度二尖瓣反流的发生率更高（p=0.001）；该组患者轻或轻中度主动脉反流的发生率同样更高（p=0.045）。慢性期结果显示，轻度风湿性心脏病患者的二尖瓣反流（p < 0.0001）与主动脉反流（p=0.009）发生率均更高，亚临床风湿性心脏病患者的无风湿性心脏病生存率更高（p=0.010）。轻度风湿性心脏病组的残余二尖瓣反流发生率更高（p < 0.0001），而两组的残余主动脉反流发生率无显著差异（p=0.099）。结论：亚临床风湿性心脏病患者的二尖瓣反流消退率更高，而主动脉反流的逆转在两组中均少见且发生率相近。（《国际心血管科学杂志》2017;30(5):391-400）