Rheumatic heart disease revisited:  patterns of valvular involvement from a consecutive cohort in eastern Nepal.
BACKGROUND
The burden of rheumatic heart disease (RHD) continues to be a major contributor to morbidity and premature death in poor and developing countries. We investigated patterns of valvular involvement in patients with RHD as observed in a large tertiary care hospital in eastern Nepal.


METHODS
We retrospectively reviewed transthoracic echocardiography reports from patients diagnosed with RHD between June 1999 and February 2011.


RESULTS
Among 10 860 transthoracic echocardiography studies, 1055 female and 658 male patients were diagnosed with RHD, 25.7% of the patients being below 20 years of age. Mitral regurgitation was the most common valvular lesion across all age groups irrespective of sex (n = 1321, 77.1%). Female patients were significantly older as compared to male patients at the time of presentation (32.8 ± 15.2 versus 28.5 ± 15.4 years; P < 0.001) and more commonly presented with mitral stenosis as compared to male patients (62.8 versus 51.5%; P < 0.001), with a peak between the age of 30 and 49 years. Conversely, aortic regurgitation was more common in men as compared to women (55.6 versus 48.9%; P = 0.007). Involvement of both the mitral and the aortic valve was observed in 49.8% of the patients and was more common in men as compared to women (52.7 versus 47.8%; P = 0.047).


CONCLUSIONS
In this consecutive cohort of patients with RHD in Nepal differential patterns of valvular involvement are observed across sex and age categories.
Department of Cardiology, BP Koirala Institute of Health, Dharan, Nepal. nikeshmd@gmail.com
Nikesh Raj
NR
Shrestha
Thomas
T
Pilgrim
Prahlad
P
Karki
Rupak
R
Bhandari
Sandeep
S
Basnet
Subikshya
S
Tiwari
Subodh Sagar
SS
Dhakal
Philip
P
Urban
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology; D009390:Nepal / Q000453:epidemiology; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017678:Sex Distribution; D012737:Sex Factors; D062606:Tertiary Care Centers; D014463:Ultrasonography; D055815:Young Adult