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Clinical features of rheumatic heart disease in Bangladesh
Insights
Rheumatic heart disease in Bangladesh shows higher mitral regurgitation (MR) and younger patients compared to Japan. Echocardiography reveals distinct mitral valve involvement patterns in Bangladeshi patients with MS and MR.
Area of Science:
- Cardiology
- Rheumatology
- Echocardiography
Background:
- Rheumatic heart disease (RHD) remains a significant global health concern, particularly in developing countries.
- Understanding regional variations in RHD clinical presentation and echocardiographic findings is crucial for targeted management.
Purpose of the Study:
- To compare the clinical and echocardiographic features of rheumatic heart disease in Bangladesh with those in Japan.
- To identify unique echocardiographic findings in Bangladeshi RHD patients.
Main Methods:
- Retrospective analysis of 205 Bangladeshi RHD cases and 387 Japanese RHD cases.
- Two-dimensional echocardiography was used to assess valvular morphology and function.
- Clinical data including age, sex, and comorbidities were compared between the two cohorts.
Main Results:
- Mitral stenosis (MS), aortic valvular diseases (A), and MS+A prevalence were similar between Bangladesh and Japan.
- Mitral regurgitation (MR) was more prevalent, while mitral stenosis and regurgitation (MSR) was less common in Bangladesh.
- Bangladeshi patients presented younger, with a lower incidence of atrial fibrillation, higher male predominance in MS, and increased pulmonary hypertension.
- Echocardiography showed distinct patterns: narrowed mitral valve orifice in MS and shortened, immobile posterior leaflets in MR in Bangladeshi patients.
Conclusions:
- Significant differences exist in the clinical and echocardiographic presentation of RHD between Bangladesh and Japan, particularly concerning MR prevalence and valve morphology.
- These findings highlight the need for geographically tailored RHD diagnostic and treatment strategies.
Abstract:
The clinical features of 205 cases of rheumatic heart disease in Bangladesh, including unique two-dimensional echocardiographic findings, were reported, and these were compared with those of 387 Japanese cases. The percentage of mitral stenosis (MS), aortic valvular diseases including both aortic stenosis and aortic regurgitation (A), mitral stenosis with aortic valvular diseases (MS + A) were almost the same between the two countries, but that of mitral regurgitation (MR) was higher, mitral stenosis and regurgitation (MSR) was lower in Bangladesh. The mean age of the patients with mitral valvular diseases was very young and the incidence of atrial fibrillation was very low in Bangladesh. Males predominated over females in MS (male/female = 1.2/1) and the incidence of pulmonary hypertension in MS was higher in Bangladesh. A two-dimensional echocardiographic examination showed that the rough zone was heavily involved in the rheumatic process with having a narrow mitral valve orifice while the clear zone was relatively spared and pliable in many patients with MS in Bangladesh. In MR, posterior mitral leaflets were shortened and made immobile by its submitral complex which were also thickened, fused and shortened, and these resulted in a gap or non-coaptation of the two leaflets in many patients.