Comparison between interventional versus medical therapy in patients with rheumatic mitral valve stenosis in Tanzania

作者：Reuben Mutagaywa, Engerasiya Kifai, Mercy Elinisa, Henry Mayala, Peter Kisenge, Tulizo Shemu, Evarist Nyawawa, Peter P. Kunambi, Respicious Boniface, Aileen Barongo, Gideon Kwesigabo, Appolinary Kamuhabwa, Steven A. J. Chamuleau, Maarten J. Cramer, Pilly Chillo · 发表于：European Journal of Clinical Investigation · 年份：2023 · DOI：10.1111/eci.14114 · 被引用次数：8 · 研究领域：Cardiac Valve Diseases and Treatments、Streptococcal Infections and Treatments、Congenital Heart Disease Studies

BACKGROUND: Rheumatic heart disease remains the most common cardiovascular disease in children and young adults. The outcome of interventional versus medical therapy on the long term is not fully elucidated yet. This study provides contemporary data on the clinical profile, treatment and follow up of patients with rheumatic mitral stenosis (MS) in Tanzania. METHODS: Patients' medical information, investigations and treatment data were recorded in this prospective cohort study. They were followed up for 6-24 months to determine the long-term outcome. Interventional therapy was defined as a combination of surgery and percutaneous balloon mitral valvuloplasty. Kaplan-Meier curves and Cox proportional hazards model were used in analyses. p-Value < 0.05 was considered statistically significant. RESULTS: We enrolled 290 consecutive patients. Interventions were done in half of the patients. Median follow up was 23.5 months. Mortality was higher in the medical than interventional treatment (10.4% vs. 4%, log-rank p = 0.001). Median age was 36 years, females (68.3%) and low income (55.5%). Multivalvular disease was found in 116 (40%) patients, atrial fibrillation (31.4%), stroke/transient ischaemic attack (18.9%) and heart failure class III-IV (44.1%). Median (IQR) duration of disease was 3 (4) years, secondary prophylaxis (27.7%) and oral anticoagulants use (62.3%). In multivariable analysis, the risk of death among patients on medical was 3.07 times higher than those on intervention...