title: Prediction of residual valvular lesions in rheumatic heart disease: role of adhesion molecules.
abstract: Rheumatic heart disease (RHD) is a chronic condition characterized by fibrosis and scarring of the cardiac valves and damage to the heart muscle, leading to congestive heart failure and death. This prospective cohort study was conducted to investigate the possible relation between the levels of serum adhesion molecules and acute rheumatic fever (ARF) carditis, valvular insult severity, and residual valvular lesion after improvement of rheumatic activity. Serum levels of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin were assayed by enzyme-linked immunoassay (ELISA) for 50 children with ARF carditis during activity and after improvement and for 50 healthy children as control subjects. After the acute attack, patients were followed up regularly to detect residual valvular lesion. The serum levels of these adhesion molecules were significantly higher in the patients than in the control group (p < 0.001). In addition, the levels of serum adhesion molecules were significantly higher in the patients with severe carditis than in the patients with mild to moderate carditis (p < 0.001). Among the severe carditis group, the level of serum adhesion molecules was significantly higher among the patients with heart failure than among the patients without heart failure (p < 0.001). Furthermore, the pretreatment serum levels of ICAM-1 and VCAM-1 were significantly higher among the patients with residual valve lesion (p = 0.002) than among those without the lesion (p < 0.001). The cutoff values were obtained for the prediction of residual valvular lesion (ICAM-1, >1,032.3 μg/ml; VCAM-1, >3,662.3 μg/ml; E-selectin, >104.8 μg/ml). Finally, by combining the three adhesion molecules in a single prediction model, the highest area under the curve (AUC) ± standard error (SE) was obtained (0.869 ± 0.052), and the positive likelihood ratio for having a residual valvular lesion was increased (17.33). Levels of serum adhesion molecules could predict residual valvular lesions in RHD patients. The authors recommend that the serum level of adhesion molecules be measured in all cases of ARF carditis.
authors.affiliation: Pediatric Department, Faculty of Medicine, Mansoura University Children's Hospital, Mansoura, 35516, Egypt.
authors.forename: Mona
authors.initials: M
authors.lastname: Hafez
authors.forename: Sohier
authors.initials: S
authors.lastname: Yahia
authors.forename: Waleed
authors.initials: W
authors.lastname: Eldars
authors.forename: Heba
authors.initials: H
authors.lastname: Eldegla
authors.forename: Mohamed
authors.initials: M
authors.lastname: Matter
authors.forename: Gehan
authors.initials: G
authors.lastname: Attia
authors.forename: Samia
authors.initials: S
authors.lastname: Hawas
mesh_terms: D000293:Adolescent; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D015815:Cell Adhesion Molecules / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D018450:Disease Progression; D019040:E-Selectin / Q000097:blood / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000097:blood* / Q000453:epidemiology*; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood / Q000378:metabolism; D008297:Male; D009205:Myocarditis / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D011237:Predictive Value of Tests; D012372:ROC Curve; D012008:Recurrence; D012016:Reference Values; D012214:Rheumatic Heart Disease / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D018709:Statistics, Nonparametric; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood / Q000378:metabolism
chemical_list: D015415:Biomarkers; D015815:Cell Adhesion Molecules; D019040:E-Selectin; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1