Pattern of valvular involvement causing atrial fibrillation and stroke in patients with rheumatic heart disease: a hospital based observational study

Abstract

Background: Rheumatic heart disease (RHD) is common in developing countries like Nepal causing high morbidity and mortality among young population. Complications like atrial fibrillation and ischemic stroke is also highly prevalent. This study is aimed at evaluating the pattern of valve involvement causing atrial fibrillation and stroke in the western part of Nepal.

Materials and methods: A retrospective study was designed. Data of echocardiography reports from January 2015 through December 2017 were collected in a prestructured proforma and analyzed.

Results: A total of 7248 patients underwent echocardiography during the study period.  Among them 294 (4.05%) patients had RHD. Females predominated with male to female ratio of 1:2.3. Most patients, 180 (61%) belonged to age group of 21–40 years. The commonest mixed lesion featuring mitral stenosis (MS) with mitral regurgitation (MR) and aortic regurgitation (AR) was commonly seen in 113(38.4%).  The commonest isolated lesion was MR (17%) followed by MS (7%).  The frequency of atrial fibrillation (AF) and stroke was 26% and 9.5% respectively in RHD patients. AF and stroke was commonest in patients having mitral valve disease and associated with MS. The prevalence of AF and stroke in MS (either isolated or mixed form) was higher as compared to valvular lesions without MS (26 versus 2), odds ratio being 17.031 and 42.7742 respectively. The mean left atrial size in patients with MS was 5.3+0.7 cm.

Conclusion: The proportion of AF and ischemic stroke in patients with RHD was high in this study. MS either isolated or combined with other valvular lesions is the major culprit. Aim to prevent at community level with screening programs might help reduce the disease burden and sequel.