Abstract:
Introduction: The World Health Organization (WHO) estimates that Rheumatic fever and Rheumatic Heart disease affects about 15.6 million people globally, with 282,000 new cases and 233,000 deaths occurring annually. Pulmonary hypertension is one of the main complications of cardiac diseases which suggest an advanced cardiac disease; particularly in valvular heart disease because it is independently associated with increased morbidity and mortality. There are only few studies in Ethiopia that showed the magnitude of pulmonary hypertension in RHD patients. This study was done to identify the prevalence and predictors of PH in RHD patients so that early identification and intervention can be done for those at risk to develop PH.
Method: An institution-based retrospective study was employed. Systolic PAP >35mmHg using 2D echocardiography was used to diagnose pulmonary hypertension. Data were collected using structure questionnaire by reviewing medical records of patients. The collected data were entered into Epidata version 4.6 and exported into SPSS 25 for analysis. Both Bivariate and multivariate binary logistic regression analyses were done to identify factors associated with pulmonary hypertension. Variables with a p-value < 0.05 in the multivariable logistic regression analysis were considered to have significant association.
Result: A total of 230 RHD patients were included between September 2017 and September 2022. PH prevalence was found to be high in this study which is 77.4% (95% CI: 71.4%, 82.6%). Most patients (51.3%) had severe PH (≥60mmHg), whereas Mild PH (36 – 44mmHg) was 7.4% and moderate PH (45-59mmHg) was 18.7%. PH was found to have significant association with severe MS (AOR=5.31, 95%CI: 1.87, 15.06), moderate to severe MR (AOR = 2.68, 95% CI: 1.05, 6.84), NYHA functional class III and IV (AOR = 2.60, 95% CI: 1.01, 6.68) and Diuretics (AOR=4.43, 95% CI: 1.33, 14.70).
Conclusion: The prevalence of PH among rheumatic heart disease patients in this study was high compared to other studies. Moderate to severe MR, severe MS, NYHA class III and IV, and diuretics use were significantly associated with PH. So, early detection of PH and severe valvular lesions in RHD patients and early referral to a site capable of surgical interventions would decrease PH prevalence and morbidity and mortality associated with it.
