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Ongoing inflammation in children with rheumatic heart disease
Nevin M M Habeeb1, Iman S Al Hadidi
1Pediatric Cardiology Department and Clinical Pathology Department, Ain Shams University, 15 A Saraya Al Kobba Square, Cairo, Egypt. nhabeeb69@yahoo.com
Insights
Children with rheumatic heart disease show ongoing inflammation, indicated by elevated high-sensitivity C-reactive protein and homocysteine levels. This inflammation correlates with valvular damage and may increase the risk of early atherosclerosis.
Area of Science:
- Pediatric Cardiology
- Rheumatology
- Inflammation Biomarkers
Background:
- Rheumatic heart disease (RHD) is a significant cause of acquired heart disease in children globally.
- The role of ongoing inflammation in the progression of RHD and its long-term consequences remains an area of active investigation.
Purpose of the Study:
- To investigate the presence and extent of ongoing inflammation in children diagnosed with acute rheumatic carditis and chronic rheumatic heart disease.
- To explore the correlation between inflammatory markers, valvular involvement, and cardiac function in pediatric RHD patients.
Main Methods:
- A cohort of 36 pediatric patients (mean age 12.63 years) with RHD (acute or chronic) and 15 healthy controls were enrolled.
- Echocardiography assessed valvular disease and left ventricular function.
- Laboratory tests included lipid profiles, high-sensitivity C-reactive protein (hs-CRP), and homocysteine assays.
Main Results:
- Patients with RHD exhibited significantly elevated hs-CRP and homocysteine levels compared to controls.
- hs-CRP levels showed a positive correlation with the severity of mitral regurgitation.
- No significant correlation was found between inflammatory markers and lipid profiles.
Conclusions:
- Evidence suggests persistent inflammation in children with RHD, directly linked to the degree of valvular damage.
- This chronic inflammation may predispose these young patients to premature atherosclerotic cardiovascular disease.
Aim Of The Work:
To elucidate the hypothesis of ongoing inflammation in children with chronic rheumatic heart disease, and its possible consequences.
Subjects And Methods:
This study was conducted on 36 patients with a mean age of 12.63 years: six with acute rheumatic carditis, and 30 with chronic rheumatic heart disease. There were 15 age- and sex-matched children who served as a control group. All subjects underwent echocardiographic assessment of valvular involvement and left ventricular function. Laboratory investigations comprised lipid profile, high-sensitivity C-reactive protein, and homocysteine assay.
Results:
High-sensitivity C-reactive protein was significantly elevated in patients with acute rheumatic carditis and in patients with chronic rheumatic heart disease (mean and standard deviation of 78.33, 156 micrograms per millilitre and 78.33, 23.17 micrograms per millilitre, respectively) as compared to the control group (mean and standard deviation of 5.83 and 2.79 micrograms per millilitre). High-sensitivity C-reactive protein correlated with the grade of mitral regurgitation (p less than 0.05). Homocysteine was significantly elevated in patients with acute carditis and patients with rheumatic heart disease as compared to the control group (their mean and standard deviation were 2.96, 0.476 nanograms per decilitre, 2.99, 1.48 nanograms per decilitre, and 1.717, 0.733 nanograms per decilitre, respectively), but did not show significant difference between the two studied groups of patients. Neither C-reactive protein nor homocysteine correlated with any of the studied parameters of lipid profile.
Conclusion:
There is evidence of ongoing inflammation in children with rheumatic heart disease, which correlates with the degree of valvular involvement. This ongoing inflammation may put those children at risk for premature atherosclerosis.
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