CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 2, May – August 2024 AFRICA 89 A cross-sectional study of the spectrum, aetiology and clinical characteristics of adult mitral valve disease at Chris Hani Baragwanath Academic Hospital Ebrahim Banderker, Geert Roozen, Merika Tsitsi, Ruchika Meel Abstract Background: Valvular heart disease constitutes a considerable amount of cardiovascular morbidity and mortality worldwide. There is a scarcity of data from Africa. Methods: In this descriptive, cross-sectional study, we documented the demographic, clinical and echocardiographic features of current patients with adult mitral valve disease (MVD) at Chris Hani Baragwanath Academic Hospital from December 2018 to March 2019. Results: The study included 134 patients (mean age 50 ± 13.3 years) and 77% were female. The majority were of African ethnicity (96%). Mitral regurgitation (39%), followed by mixed MVD (38%) were the dominant lesions. Mitral stenosis was found in 23% of the patients. The main aetiologies were rheumatic heart disease (80%), mitral valve prolapse (11%), myxomatous degeneration (6%) and infective endocarditis (3%). Hypertension (30%) and HIV (12%) were the main co-morbidities. Heart failure was present in 78% of the patients at index hospitalisation. The main complications were pulmonary hypertension (28%) and atrial fibrillation (14%). Conclusion: The patients with MVD tended to be older African females with co-morbidities who had predominant rheumatic mitral regurgitation. Keywords: mitral valve disease, echocardiography, Africa, rheumatic heart disease Submitted 9/3/22, accepted 27/2/23 Published online 25/4/23 Cardiovasc J Afr 2024; 35: 89–94 www.cvja.co.za DOI: 10.5830/CVJA-2023-009 Valvular heart disease (VHD) remains a frequent aetiology of heart failure (HF).1 It constitutes a considerable cause of cardiovascular morbidity and mortality worldwide.2 In developed countries, degenerative valve disease is the most common aetiology of VHD.3 Rheumatic heart disease (RHD) is responsible for the majority of VHD in developing countries, with mitral valve disease (MVD) being a common lesion.3 There is a scarcity of data in developing countries with regard to demographic information such as age and gender; symptoms and functional class; co-morbidities; aetiology of the valve lesion(s); and severity and complications of adult MVD. A study done by Sliwa et al. at Chris Hani Baragwanath Academic Hospital (CHBAH) in a similar setting focused on newly diagnosed RHD patients.1 From the available literature from developing countries, the mean/median age for patients with adult MVD was between 20 and 39 years.4,5 Females were found to have a greater prevalence of adult MVD than males.6 The most common symptoms included dyspnoea, decline in effort tolerance, palpitations and chest pains. Hypertension, diabetes mellitus, strokes and thyroid disease were common co-morbidities. Patients with adult MVD were reported to have New York Heart Association (NYHA) class III/IV symptoms.1 Mitral regurgitation (MR) was documented as the most common isolated adult valve lesion.4,7 The predominance of mitral stenosis (MS) in female patients was almost exclusively related to RHD in all the previous literature.7 RHD was the commonest aetiology in developing countries as opposed to degenerative calcific disease in developed countries. This was followed by mitral valve prolapse (MVP), myxomatous MVD, and ischaemic, infective and auto-immune disease. Most of the patients had moderate to severe valve dysfunction. The general complications of adult MVD patients included atrial fibrillation (AF) and pulmonary hypertension.5,7 Norecentstudyhasexploredtheclinicalandsocio-demographic profile of patients with MVD at CHBAH. We suspect that there has been a change in the clinical and demographic characteristics of these patients compared to the past, due to an aging population with better healthcare access,8 and a decline in acute rheumatic fever (ARF).9 Therefore the objective of this study was to describe the demographics, spectrum, aetiology, clinical and echocardiographic characteristics, and management of current adult MVD patients at CHBAH. Methods This was a descriptive, cross-sectional analysis and review of 134 patientswithMVDconductedbetweenDecember2018andMarch 2019. The study was performed in accordance with guidelines set out in the World Medical Association Declaration of Helsinki – Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa Ebrahim Banderker, MMed, FCP, heib15@yahoo.com Julius Global Health Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands Geert Roozen, MD Department of Internal Medicine, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, Johannesburg, South Africa Merika Tsitsi, FCP Division of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Ruchika Meel, MB ChB, MMed, Cert Cardiology (SA), PhD, FEACVI, FESC, ruchikameel@gmail.com
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