Outcome following acute and recurrent rheumatic fever

ABSTRACT

Background

Rheumatic carditis is the leading cause of permanent disability caused by damage of the cardiac valve. This study aimed to determine the outcome and predictors of valve surgery in patients with acute rheumatic fever (ARF) and recurrent rheumatic fever (RRF).

Methods

This was a retrospective study of patients diagnosed with ARF and RRF between 2006 and 2021. The predictors of valve surgery were analysed using multivariable Cox proportional regression.

Results

The median age of patients with ARF and RRF (n=92) was 11 years (range 5–18). Seventeen patients (18%) were diagnosed with RRF. The most common presenting symptoms included clinical carditis (87%), heart failure (HF) (63%), fever (49%) and polyarthralgia (24%). Patients with moderate-to-severe rheumatic carditis (88%) were given prednisolone. After treatment, the severity of valvular regurgitation was reduced in 52 patients (59%). Twenty-three patients (25%) underwent valve surgery. The incidence of HF, RRF, severe mitral regurgitation on presentation, left ventricular enlargement and pulmonary hypertension was greater in the surgical group than in the non-surgical group. Recurrent rheumatic fever (hazard ratio 7.9, 95% CI 1.9–33.1), tricuspid regurgitation (TR) gradient ≥ 42 mmHg (HR 6.3, 95%CI 1.1–38.7) and left ventricular end-diastolic dimension (LVEDD) ≥6 cm (HR 8.7, 95% CI 2.1–35.9) were predictors of valve surgery (multivariable Cox proportional regression analysis).

Conclusion

Clinical carditis was the most common presenting symptom in patients with ARF and RRF. The majority of patients responded positively to prednisolone. These findings highlight the predictors of valve surgery following ARF, including RRF, TR gradient ≥ 42 mmHg and LVEDD ≥ 6 cm.

Abbreviations: ARF: acute rheumatic fever; CRP: C-reactive protein; ESR: erythrocyte sedimentation rate; GAS: group A beta-haemolytic Streptococcus; HF: heart failure; HR: hazard ratio; LVEDD: left ventricular end-diastolic dimension; MR: mitral regurgitation; RHD: rheumatic heart disease; RRF: recurrent rheumatic fever; TR: tricuspid regurgitation.

KEYWORDS:

• Acute rheumatic fever
• rheumatic heart disease
• recurrent rheumatic fever
• Jones criteria

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

Suchaya Silvilairat: Conceptualisation, methodology, data curation, formal analysis, writing original draft and editing; Artit Sornwai: Conceptualisation, methodology, data curation and formal analysis; Saviga Sethasathien: Conceptualisation, methodology, formal analysis and editing; Kwannapas Saengsin: Conceptualisation; Krit Makonkawkeyoon: Conceptualisation; Rekwan Sittiwangkul: Conceptualisation, methodology and supervision; Yupada Pongprot: Conceptualisation, methodology and supervision.

Data availability statement

Research data will be available upon reasonable request. All requests should be submitted to the corresponding author who will review them with the other investigators for consideration. A data use agreement will be required before the release of participant data and Institutional Review Board approval as appropriate.

Additional information

Funding

The authors reported that no funding was associated with the work featured in this article.