Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-24T02:01:23.321Z Has data issue: false hasContentIssue false

Clinical and functional characterisation of rheumatic mitral regurgitation in children and adolescents including the brain natriuretic peptide

Published online by Cambridge University Press:  24 February 2010

Maria C. V. Ribeiro*
Affiliation:
Department of Pediatric Cardiology, Instituto Materno Infantil Professor Fernando Figueira (IMIP), Recife-Pernambuco
Brivaldo Markman Filho
Affiliation:
Centro de Ciências da Saúde da UniversidadeFederal de Pernambuco, Department of Cardiology, Recife-Pernambuco, Brasil
Cleusa C. L. Santos
Affiliation:
Department of Pediatric Cardiology, Instituto Materno Infantil Professor Fernando Figueira (IMIP), Recife-Pernambuco
Cristina P. Q. Mello
Affiliation:
Department of Pediatric Cardiology, Instituto Materno Infantil Professor Fernando Figueira (IMIP), Recife-Pernambuco
*
Correspondence to: Maria C. V. Ribeiro, Rua Leonardo Bezerra Cavalcanti, número 300, Ap302, Jaqueira, Recife PE, Brasil, CEP52060030. Tel: 558121224770; Fax: 558121376500; E-mail: [email protected]

Abstract

Rheumatic fever is a public health problem of universal distribution, predominantly affecting individuals in developing countries. In individuals less than 20 years of age, pure mitral regurgitation is the most commonly found condition in chronic rheumatic valve disease. In the present study, rheumatic mitral regurgitation was assessed in children and adolescents, addressing its clinical (duration of the disease, symptoms, use of benzathine penicillin, and number of outbreaks of the acute phase of rheumatic fever), electrocardiographic (left atrium abnormality and/or left ventricle hypertrophy) and echocardiographic characteristics (left atrium and ventricle measurements, ejection fraction and pulmonary artery pressure), as well as plasma dose of N-terminal portion of the brain natriuretic peptide through electrochemiluminescence immunoassay. Fifty-three patients were studied. The patients had moderate (41.5%) or severe (58.5%) rheumatic mitral regurgitation; had not undergone surgery; were not in the acute phase of the disease; and were being treated at a paediatric cardiology reference hospital in Northeastern Brazil. Mean patient age was 10.6 years (minimum of 3 and maximum of 19 years). With the exception of the ejection fraction, the echocardiographic variables had a significant correlation to the natriuretic peptide, demonstrating that this hormone reflects the haemodynamic consequences of mitral regurgitation. It was concluded that cardiac remodelling that occurs in rheumatic mitral regurgitation in children and adolescents leads to the production of the brain natriuretic peptide, which could be used as a complementary diagnostic tool in the follow-up of such patients.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Ravisha, MS, Tullu, MS, Kamat, JR. Rheumatic fever and rheumatic heart disease: clinical profile of 550 cases in India. Arch Med Res 2003; 34: 382387.CrossRefGoogle ScholarPubMed
2.Marcus, RH, Sareli, P, Pocock, WA, Barlow, JB. The spectrum of severe rheumatic mitral valve disease in a developing country: correlations among clinical presentation, surgical pathologic findings, and hemodynamic sequelae. An Int Med 1994; 120: 177183.CrossRefGoogle Scholar
3.Crawford, MH, Souchek, J, Oprian, CA, et al. Determinants of survival and left ventricular performance after mitral valve replacement. Circulation 1990; 81: 11731181.CrossRefGoogle ScholarPubMed
4.Enriquez-Sarano, M, Tajik, AJ, Schaff, HV, Orszulak, TA, Bailey, KR, Frye, RL. Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation. Circulation 1994; 90: 830837.CrossRefGoogle ScholarPubMed
5.Stewart, WJ. Myocardial factor for timing of surgery in asymptomatic patients with mitral regurgitation. Am Heart J 2005; 146: 58.CrossRefGoogle Scholar
6.Lee, JY, Noh, CI, Bae, EJ, Yun, YS, Lee, RJ, Kim, YJ. Preoperative left ventricular end systolic dimension as a predictor of postoperative ventricular dysfunction in children with mitral regurgitation. Heart 2003; 89: 12431244.CrossRefGoogle ScholarPubMed
7.Bonow, RO, Carabello, BA, Chatterjee, K, et al. ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. J Am Coll Cardiol 2006; 48: e1e148.CrossRefGoogle ScholarPubMed
8.Bonow, RO, Carabello, B, deLeon, AC Jr, et al. ACC/AHA guidelines for the management of patients with valvular heart disease. Circulation 1998; 98: 19491984.CrossRefGoogle Scholar
9.Matsumura, T, Ohtaki, E, Tanaka, K, et al. Echocardiographic prediction of left ventricular dysfunction after mitral valve repair for mitral regurgitation as an indicator to decide the optimal timing of repair. J Am Coll Cardiol 2003; 42: 458463.CrossRefGoogle ScholarPubMed
10.Schuler, G, Peterson, KL, Johnson, A, et al. Temporal response of left ventricular performance to mitral valve surgery. Circulation 1979; 59: 12181231.CrossRefGoogle ScholarPubMed
11.Agricola, E, Galderisi, M, Oppizzi, M, et al. Pulsed tissue Doppler imaging detects early myocardial dysfunction in asymptomatic patients with severe mitral regurgitation. Heart 2004; 90: 406410.CrossRefGoogle ScholarPubMed
12.Rodeheffer, RJ. Measuring plasma B-type natriuretic peptide in heart failure. Good to go in 2004? J Am Coll Cardiol 2004; 44: 740749.Google ScholarPubMed
13.Ray, SG. Natriuretic peptides in heart valve disease. Heart 2006; 92 (9): 11941197.CrossRefGoogle ScholarPubMed
14.Detaint, D, Messika-Zeitoun, D, Avierinos, JF, et al. B-type natriuretic peptide in organic mitral regurgitation: determinants and impact on outcome. Circulation 2005; 111: 23912397.CrossRefGoogle ScholarPubMed
15.Gölbaþý, Z, Uçar, O, Yüksel, AG, Gülel, O, Aydoğdu, S, Ulusoy, V. Plasma brain natriuretic peptide levels in patients with rheumatic heart disease. Eur J Heart Fail 2004; 6: 757760.CrossRefGoogle Scholar
16.World Health Organisation. WHO expert consultation on rheumatic fever and rheumatic heart disease. In: Rheumatic Fever and Rheumatic Heart Disease: Report of a WHO Expert Consultation. Geneva, 2001, 130p.Google Scholar
17.Ferrieri, P, Jones Criteria Working Group. Proceedings of the Jones Criteria workshop. Circulation 2002; 106: 25212523.CrossRefGoogle Scholar
18.Câmara, EJ, Neubauer, C, Câmara, GF, Lopes, AA. Mechanisms of mitral valvar insufficiency in children and adolescents with severe rheumatic heart disease: an echocardiographic study with clinical and epidemiological correlations. Cardiol Young 2004; 14: 527532.CrossRefGoogle ScholarPubMed
19.Garson, A Jr (ed.) Electrocardiography. In: The science and practice of pediatric cardiology, 2nd edn.Williams & Wilkins, Baltimore, 1998: 735788.Google Scholar
20.Sanches, PCR, Moffa, PJ. (eds) O eletrocardiograma e o vetocardiograma na sobrecarga ventricular esquerda. In: Eletrocardiograma: Normal e Patológico, 7th edn.Editora Roca, São Paulo, 2001: 173188.Google Scholar
21.Lang, RM, Bierig, M, Devereux, RB, et al. Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005; 18: 14401463.CrossRefGoogle Scholar
22.Kampmann, C, Wiethoff, CM, Wenzel, A, et al. Normal values of M mode echocardiographic measurements of more than 2000 healthy infants and children in central Europe. Heart 2000; 83: 667672.CrossRefGoogle ScholarPubMed
23.Teichholz, LE, Kreulen, T, Herman, MV, Gorlin, R. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy. Am J Cardiol 1976; 37: 711.CrossRefGoogle ScholarPubMed
24.Zoghbi, WA, Enriquez-Sarano, M, Foster, E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr 2003; 16: 777802.CrossRefGoogle ScholarPubMed
25.Roberts, BJ, Grayburn, PA. Color flow imaging of the vena contracta in mitral regurgitation: technical considerations. J Am Soc Echocardiogr 2003; 16: 10021006.CrossRefGoogle ScholarPubMed
26.Du Bois, D, Du Bois, EF. A formula to estimate the approximate surface area if height and weight be known. Arc Intern Med 1916; 17: 863.CrossRefGoogle Scholar
27.Terreti, MTRA, Caldas, AM, Leon, CA, Ultchak, F, Hilário, MOE. Características clínicas e demográficas de 193 pacientes com febre reumática. Ver Brás Reumatol 2006; 46: 385390.Google Scholar
28.McLaren, MJ, Markowitz, M, Gerber, MA. Rheumatic heart disease in developing countries: the consequence of inadequate prevention. Ann Intern Med 1994; 120: 243245.CrossRefGoogle ScholarPubMed
29.Hillman, ND, Tani, LY, Veasy, LG, et al. Current status of surgery for rheumatic carditis in children. Ann Thorac Surg 2004; 78: 14031408.CrossRefGoogle ScholarPubMed
30.Chauvaud, S, Fuzellier, JF, Berrebi, A, Deloche, A, Fabiani, JN, Carpentier, A. Long-term (29 years) results of reconstructive surgery in rheumatic mitral valve insufficiency. Circulation 2001; 104 (Suppl I): I12I15.CrossRefGoogle ScholarPubMed
31.Chauvaud, S, Perier, P, Touati, G, et al. Long-term results of valve repair in children with acquired mitral valve incompetence. Circulation 1986; 74 (Suppl I): I104I109.Google ScholarPubMed
32.Meneghelo, ZM, Magalhães, HM, Ramos, AIO, et al. Sensibilidade e especificidade do hormônio natriurético do tipo B para identificar doentes com insuficiência mitral grave sintomáticos e assintomáticos. Arq Bras Cardiol 2004; 83: 2125.CrossRefGoogle Scholar
33.Sutton, TM, Stewart, RA, Gerber, IL, et al. Plasma natriuretic peptide levels increase with symptoms and severity of mitral regurgitation. J Am Coll Cardiol 2003; 41: 22802287.CrossRefGoogle ScholarPubMed
34.Yusoff, R, Clayton, N, Keevil, B, Morris, J, Ray, S. Utility of plasma N-terminal brain natriuretic peptide as a marker of functional capacity in patients with chronic severe mitral regurgitation. Am J Cardiol 2006; 97: 14981501.CrossRefGoogle ScholarPubMed
35.Hosoda, K, Nakao, K, Mukoyama, M, et al. Expression of brain natriuretic peptide gene in human heart. Production in the ventricle. Hypertension 1991; 17 (Pt 2): 11521155.CrossRefGoogle ScholarPubMed
36.Nagaya, N, Nishikimi, T, Uematsu, M, et al. Plasma brain natriuretic peptide as a prognostic indicator in patients with primary pulmonary hypertension. Circulation 2000; 102: 865870.CrossRefGoogle ScholarPubMed
37.Nir, A, Bar-Oz, B, Perles, Z, Brooks, R, Korach, A, Rein, AJ. N-terminal pro-B-type natriuretic peptide: reference plasma levels from birth to adolescence. Elevated levels at birth and in infants and children with heart diseases. Acta Pediatric 2004; 93: 603607.CrossRefGoogle ScholarPubMed
38.Price, JF, Thomas, AK, Grenier, M, et al. B-type natriuretic peptide predicts adverse cardiovascular events in pediatric outpatients with chronic left ventricular systolic dysfunction. Circulation 2006; 114: 10631069.CrossRefGoogle ScholarPubMed
39.Detaint, D, Messika-Zeitoun, D, Chen, HH, et al. Association of B-type natriuretic peptide activation to left ventricular end-systolic remodeling in organic and functional mitral regurgitation. Am J Cardiol 2006; 97: 10291034.CrossRefGoogle ScholarPubMed