Prevalence, pattern and trend of rheumatic heart disease in a tertiary hospital in Nigeria: A 12-year retrospective echocardiographic study
Authors: Shogade T T , Udosen A U , Udoh E M , Tanimowo M O , Ukpong O Y , Nwabueze C U , Umoh I O , Essien C E , Ekrikpo U E , Ekpe E E , Ojji D B 
Published: November 2023

Abstract

Introduction
Though the health-related burden of rheumatic heart disease has been reported to decline worldwide, rheumatic Heart Disease (RHD) still remains one of the major causes of death and disability in developing countries.(1)
In 2019, RHD affected about 40.5 million people globally and caused over 300,000 deaths, mostly in low and middle-income countries (LMICs), with the potential to undermine national productivity since it affects the most productive part of the population.(2) This preventable, treatable but not curable form of cardiovascular disease is needlessly killing many, mainly due to the misunderstanding of its burden in these countries.

Purpose
To determine the prevalence, pattern and trend of RHD over the 12-year period in our facility using echocardiography.

Methods
This hospital services population of 6.3 million people in the region.(3) In this retrospective cross-sectional study, transthoracic echocardiography (TTE) data collected from cardiology unit in our facility over a twelve-years period (2009 to 2020) were reviewed. RHD diagnosis was based on the World Heart Federation Criteria for the diagnosis of RHD.(4) Patients with a diagnosis of RHD were identified and presented as a proportion of the total number of cardiac diseases presenting at the facility. Demographic data, pattern of valvular involvement and echocardiographic indications were recorded. The Cochran-Armitage trend test was used to identify the presence of a trend in the RHD proportion across the 12 years.

Results
Over a 12-year period from 2009 to 2020, 3311 TTE was done and 3259 (98.43%) results were correctly captured. Seven hundred and ninety-one had RHD at prevalence of 24.27% over the period. More females had RHD compared to males (56.05%versus 43.95%), p=0.06. Those with RHD were significantly younger than those without RHD (48.34 versus 52.14 years, p&lt;0.001).
Pure mitral regurgitation (MR) was the commonest valve lesion seen in 258 patients (32.62%), and was frequently associated with aortic regurgitation (AR) in 263 patients (33.29%), followed by pure AR in 200 patients (25.28%). Nineteen patients (2.40%) had pure aortic stenosis (AS), 10 patients (1.26%) had mixed AR + AS. Six patients (0.76%) had MR + AS, as well as pure MS respectively and only 4 patients (0.51%) had MR + MS.
The highest prevalence was recorded in 2011 at 46.6% and 46.2% in 2012. The lowest prevalence were seen in 2019 (12.4%) and 2016 (13.2%). Prevalences were higher in the first 5 years (2009 to 2013) and began to reduce from 2014 to 2022. The commonest indications for TTE were hypertensive heart disease (40.06 %), congestive heart failure (24.66%) and valvular heart disease (9.55%).

Conclusion
RHD is still an important cause of cardiac morbidity despite the decreasing trend in recent years and the commonest valve lesion was mitral regurgitation. It will be valuable to investigate latent RHD and patients’ outcomes for better estimate of the burden of the disease.Comparing patterns of valve abnormalityTrend of Rheumatic heart disease