A LONGITUDINAL STUDY ON THE EVOLUTION OF ECHOCARDIOGRAPHIC PARAMETERS IN CHILDREN TREATED FOR RHEUMATIC HEART DISEASE

Abstract

Objective:
The primary objective of this longitudinal study was to evaluate the evolution of key echocardiographic parameters left ventricular ejection fraction (LVEF), left atrial size, and mitral valve regurgitation in children aged 5 to 15 years diagnosed with Rheumatic Heart Disease (RHD) for 12 months. The secondary objectives included assessing the development of heart failure, the need for surgical intervention, and the occurrence of adverse events during the study.

Methods:
This study was conducted as a longitudinal observational study at Department of Paediatrics, Abbasi Shaheed Hospital, Karachi in the duration from August, 2023 to July, 2024. Participants were selected based on specific inclusion and exclusion criteria and received standard medical treatment for RHD, including regular antibiotic prophylaxis and anti-inflammatory therapy. Statistical analyses, including repeated-measures ANOVA, were applied to compare changes in echocardiographic parameters, with a focus on identifying significant improvements or deteriorations.

Results:
The study enrolled 100 children, with significant improvements observed in primary outcomes over the 12 months. The mean LVEF increased from 58.3% at baseline to 62.4% at twelve months (p < 0.001). A decrease in left atrial size was also observed (p = 0.042). Mitral valve regurgitation improved in some participants, with 36% showing no significant regurgitation at the study's end. However, 15% of participants developed heart failure, with 10% requiring hospitalization, and 5% requiring surgical intervention due to progressive valve regurgitation.

Conclusion:
The study demonstrates that standard treatment for RHD can lead to significant improvements in echocardiographic parameters in children. However, the persistence of heart failure in some participants indicates the chronic nature of RHD, necessitating ongoing monitoring and individualized treatment strategies. These findings suggest that early and continuous intervention is crucial for improving clinical outcomes in pediatric RHD patients.