Rheumatic Heart Disease in Uganda : Results from more than 600 echocardiograms in a no-profit hospital

Background: Worldwide, Rheumatic Heart Disease (RHD) results in about 233 000 deaths annually. The World Health Organization (WHO) estimates that more than 16 million people are currently affected. While the prevalence have been decreasing in developed nations, RHD continues to be major causes of morbidity and mortality among young people in developing nations. The resulting cardiac valvular damage, or RHD, is the only long-term consequence of acute rheumatic fever. Lack of primary prevention (treatment of group A streptococcal infections) and wide screening programs to detect early stages of RHD, result in late presentation, with most patients seeking medical care due to long-term structural complications, such as heart failure, (HF) atrial fibrillation and stroke. Purpose: Describe the prevalence and the main echocardiographic futures of RHD in a large cohort of patients in a Ugandan hospital. Methods: We analyzed echocardiograms data in more than 600 consecutive patients performed in a no-profit hospital in Uganda in a 5 months period (Oct 2014 - Feb 2015). RHD was diagnosed according to WHO criteria and valvular disease severity was assessed according to most recent guidelines. RESULTS: A total number of 633 patients was enrolled (Age 1-96; Male 42%). RHD was diagnosed in 58 pts (9.2%, age 30.3 ± 20years), most of them referred with HF symptoms (n=42, 75%). RHD patients were younger and with more severe cardiac involvement compared to controls (Tab.1). Mitral valve was involved in all the cases (n=56, 100%) with severe or massive regurgitation in 31 pts (55%), moderate in 3 pts (5%), mild or trivial in 19 pts (34%). Significant mitral stenosis was found in 7 pts (12%). Aortic valve disease was associated in 19 pts (34%) with a severe regurgitation in 4 pts (7%). No aortic stenosis or right side valve disease were noted. Ejection fraction (EF) was reduced (<55%) in 28 pts (48%). Conclusion: Mitral valve disease was found in all the cases of RHD with the majority of the patients having a severe valvular dysfunction. Mitral stenosis and aortic regurgitation were also common due to an aggressive pattern of the disease. In absence of wide screening programs, many patients present in a late stage of the disease, with severe valvular damage.