Incidence and characteristics of newly diagnosed rheumatic heart disease in Urban African adults: insights from the Heart of Soweto Study
Incidence and characteristics of newly diagnosed rheumatic heart disease in Urban African adults: insights from the Heart of Soweto Study
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DOI：
10.1093/eurheartj/ehp530
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发表时间：
2010-03-01
影响因子：
39.3
通讯作者：
Stewart, Simon
中科院分区：
文献类型：
--
作者：
Sliwa, Karen;Carrington, Melinda;Stewart, Simon
对于处于流行病学转变阶段的非洲城市社区新诊断出的成年风湿性心脏病 (RHD) 的发病率和临床特征知之甚少。Chris Hani Baragwanath 医院为南非索韦托 110 万黑人社区提供服务。一项前瞻性临床登记记录了 2006/2007 年向心脏病科提交的所有结构性和功能性瓣膜性心脏病 (VHD) 新发病例的数据。我们详细描述了所有新诊断的 RHD 病例。 2006/2007 年有 4005 例新发病例，其中 960 例 (24%) 存在瓣膜异常。其中，344 例（36%）被诊断为 RHD。该地区 14 岁以上人群的 RHD 新发病例估计每年为 23.5 例/10 万人。大多数是非洲黑人女性 (n = 234-68%)，年龄特征与男性相似 [中位数 41（四分位距 30-55）岁 vs. 42（四分位距 31-55）岁]。主要瓣膜病变（n = 204，59%）是二尖瓣反流（MR），分别有 48 例（14%）和 43 例（13%）病例出现主动脉加 MR 和混合二尖瓣 VHD 的组合病变。 28/204 例 (14%) 主要 MR 病例和 23/126 例 (18%) 主动脉瓣关闭不全患者发现收缩功能受损。 344 例 RHD 病例中，右心室收缩压升高 > 35 mmHg（62 例）、房颤（34 例）和贫血（27 例）分别占 18%、10% 和 8%。随后对 75 名患者 (22%) 进行了瓣膜置换/修复。初次诊断疑似细菌性心内膜炎后 30 个月内，共有 90 例病例 (26%) 入院。这些数据显示，非洲成人城市社区新诊断 RHD 的发病率很高。这些数据强烈主张在高负担国家将 RHD 首次发作作为应通报的病症，以确保通过基于登记的二级预防计划控制该疾病。
Little is known on the incidence and clinical characteristics of newly diagnosed rheumatic heart disease (RHD) in adulthood from urban African communities in epidemiologic transition.Chris Hani Baragwanath Hospital services the black African community of 1.1 million people in Soweto, South Africa. A prospective, clinical registry captured data from all de novo cases of structural and functional valvular heart disease (VHD) presenting to the Cardiology Unit during 2006/07. We describe in detail all cases with newly diagnosed RHD. There were 4005 de novo presentations in 2006/07 and 960 (24%) had a valvular abnormality. Of these, 344 cases (36%) were diagnosed with RHD. Estimated incidence of new cases of RHD for those aged > 14 years in the region was 23.5 cases/100 000 per annum. Most were black African females (n = 234-68%) with a similar age profile to males [median 41 (interquartile range 30-55) years vs. 42 (interquartile range 31-55) years]. The predominant valvular lesion (n = 204, 59%) was mitral regurgitation (MR), with 48 (14%) and 43 (13%) cases, respectively, having combination lesions of aortic plus MR and mixed mitral VHD. Impaired systolic function was found in 28/204 cases (14%) of predominant MR and in 23/126 cases (18%) with predominant aortic regurgitation. Elevated right ventricular systolic pressure > 35 mmHg (62 cases), atrial fibrillation (34 cases), and anaemia (27 cases) were found in 18, 10, and 8% of 344 RHD cases, respectively. Subsequent valve replacement/repair was performed in 75 patients (22%). A total of 90 cases (26%) were admitted within 30 months of initial diagnosis for suspected bacterial endocarditis.These data reveal a high incidence of newly diagnosed RHD within an adult urban African community. These data argue strongly for the first episode of RHD to be made a notifiable condition in high burden countries in order to ensure control of the disease through register-based secondary prophylaxis programmes.