Pediatric rheumatic carditis in Italy and Rwanda: The same disease, different socio-economic settings
| Autor: | Craig Conard, Innocent Ndikubwimana, Daniela Palleri, Emmanuel Rusingiza Kamanzi, Gaetano Gargiulo, Ilaria Frabboni, Margherita Calicchia, Marcello Lanari, Anna Balducci, Arianna Dondi, Marianna Fabi |
|---|---|
| Přispěvatelé: | Fabi M., Calicchia M., Palleri D., Ndikubwimana I., Conard C., Rusingiza Kamanzi E., Balducci A., Frabboni I., Dondi A., Gargiulo G., Lanari M. |
| Rok vydání: | 2021 |
| Předmět: |
Pediatrics
medicine.medical_specialty Heart disease Myocarditi Rheumatic carditis Disease 030204 cardiovascular system & hematology Socioeconomic Factor Lesion 03 medical and health sciences 0302 clinical medicine Retrospective Studie medicine Humans 030212 general & internal medicine Child Retrospective Studies Mitral regurgitation business.industry Rheumatic Heart Disease Rwanda Mitral Valve Insufficiency Retrospective cohort study Acute rheumatic fever Secondary prophylaxis medicine.disease Myocarditis Italy Socioeconomic Factors Acute Disease Rheumatic carditi Rheumatic Fever medicine.symptom Cardiology and Cardiovascular Medicine business Human |
| Zdroj: | International Journal of Cardiology. 338:154-160 |
| ISSN: | 0167-5273 |
| DOI: | 10.1016/j.ijcard.2021.06.027 |
| Popis: | Background: Acute Rheumatic Fever and Rheumatic Heart Disease are the leading cause of acquired heart disease in Low-Income Countries, and a common cause in High-Income Countries. We compared rheumatic carditis, its echocardiographic presentation at diagnosis and its progression in Italy and Rwanda. Methods: Retrospective study including all consecutive patients diagnosed with rheumatic carditis in an Italian (IT) and two Rwandan Hospitals (RW). Echocardiography was performed at diagnosis and three follow-up visits. Baseline characteristics, history of primary and secondary prophylaxis and cardiovascular complications data were collected. Results: Seventy-nine and 135 patients were enrolled in IT and RW, respectively. Mitral regurgitation was the most common lesion (IT: 70%, RW: 96%) in both cohorts; mixed valve lesions and severe lesions were more prevalent in RW. Age at diagnosis (IT: 8.4 ± 2.9 yrs.; RW: 11.1 ± 2.7 yrs.; P < 0.001), adherence to secondary prophylaxis (IT: 99%; RW: 48%; P < 0.001) and history of primary prophylaxis (IT: 65%; RW: 6%; P < 0.001) were different. During the follow-up, native valve lesions completely resolved in 38% of IT and in 2% of RW patients (P < 0.001). By contrast, cardiac surgery was performed in 31% of RW and 5% of IT patients (P < 0.001). Cardiovascular complications and death were only observed in RW. Conclusions: The more severe cardiac involvement, the higher rate of valve surgery, CV complications and deaths in RW, could be due to delayed diagnosis and treatment, scarce adherence to secondary prophylaxis and differences in social determinants of health. |
| Databáze: | OpenAIRE |
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