Incidental Diagnosis of Rheumatic Myocarditis during Cardiac Surgery—Impact on Late Prognosis

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Rheumatic heart disease (n=118). Intervention: Presence of Aschoff bodies in surgical biopsy vs. Absence of Aschoff bodies. Primary outcome: Late mortality (p=0.043).

Paulo Vieira; Rodrigo G. Pereira; Carlos Branco; Vitor Emer Egypto Rosa; Marcelo Carvalho Vieira; Léa Maria Macruz Ferreira Demarchi; Lívia Santos Silva; Luiza Guilherme; Flávio Tarasoutchi; Roney Orismar Sampaio

doi:10.3390/diagnostics13203252

October 19, 2023DiagnosticsOpen Access

Incidental Diagnosis of Rheumatic Myocarditis during Cardiac Surgery—Impact on Late Prognosis

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Key result

Incidental Aschoff bodies at cardiac surgery linked to ~4-fold higher 10-year mortality.

P=0.043
n=118

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Why the study?

Rheumatic heart disease is neglected and underdiagnosed, with no completely reliable specific laboratory diagnostic test.

Does the presence of Aschoff bodies in surgical biopsies predict long-term mortality in patients undergoing heart surgery for rheumatic heart disease?

Key Points

To evaluate the clinical, epidemiological, echocardiographic, and pathological characteristics of rheumatic heart disease patients with and without Aschoff bodies detected during cardiac surgery.
Retrospective observational study analyzing 118 patients with rheumatic heart disease who underwent cardiac surgery between 1985 and 2018.
Histopathological evaluations of surgical heart biopsies were performed to determine the presence or absence of Aschoff bodies and characterize rheumatic inflammatory activity.
Conventional preoperative clinical and laboratory tests failed to identify active rheumatic carditis prior to valve repair or replacement surgery.
Patients with Aschoff bodies in their pathological results exhibited a significantly higher rate of late mortality compared to those without (22.9% vs. 5.4%, p = 0.043).
Patients in the Aschoff bodies cohort were significantly younger than those without Aschoff bodies (median age of 13 years [11–24 years] vs. 27 years [17–37 years], p = 0.001).

Study Design

Type

Observational (n=118)

Multicenter

No

Structured PICO

Does the presence of Aschoff bodies in surgical biopsies predict long-term mortality in patients undergoing heart surgery for rheumatic heart disease?

P

Population

118 patients with rheumatic heart disease who underwent cardiac valve surgery between 1985 and 2018, followed for 10 years to assess long-term outcomes based on pathology findings.

E

Exposure

Presence of Aschoff bodies in pathological findings from valvular or myocardial biopsies obtained during cardiac surgery

C

Comparator

Absence of Aschoff bodies in pathological findings from biopsies

O

Outcome

Late mortality at 10-year follow-uphard clinical

Main Result

Absolute Event Rate: 22.9% vs 5.4%

p-value: p=0.043

The incidental finding of Aschoff bodies in surgical biopsies from patients with rheumatic heart disease is associated with significantly increased long-term mortality.

Limitations

Information derived from the analysis of a single study center, which may not represent a broader population.
Retrospective nature relying on hospital records which may not contain all necessary data for complete characterization.
No detailed investigation of other autoimmune diseases was carried out.
Histopathological analysis from operative fragments may be compromised by sampling limitations (number of fragments and site of excision).
Analysis of a single study center which may not represent a broader population
Information derived from hospital records may not contain all data necessary for complete characterization
No detailed investigation of other autoimmune diseases was carried out
Histopathological analysis may be compromised due to obtaining of surgical material (number of fragments and site of excision)

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Implication

May signal higher late mortality risk after RHD surgery; hypothesis-generating and should not yet change practice.

Abstract

Rheumatic fever (RF) and rheumatic heart disease (RHD) are still highly prevalent, particularly in low- and middle-income countries. RHD is a neglected and underdiagnosed disease for which no specific laboratory diagnostic test is completely reliable. This is a retrospective observational study, which included 118 patients with RHD who underwent cardiac surgery from 1985 to 2018. The aim of this investigation was to evaluate the clinical, epidemiological, echocardiographic and pathological characteristics in two cohorts of RHD patients: one cohort with Aschoff bodies present in their pathological results and the other without such histopathological characteristics. No conventional clinical and laboratory tests for RHD myocarditis were able to identify active carditis during the preoperative phase of valve repair or replacement. Patients who had Aschoff bodies in their pathological results were younger (median age of 13 years (11–24 years) vs. 27 years (17–37 years), p = 0.001) and had higher rate of late mortality (22.9% vs. 5.4%, p = 0.043). In conclusion, the presence of Aschoff bodies in pathological findings may predict increased long-term mortality, emphasizing the importance of comprehensive pathology analysis for suspected myocarditis during heart surgery.

Discussion

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Cite This Study

Vieira et al. (2023) conducted an observational in Rheumatic heart disease (n=118). Presence of Aschoff bodies in surgical biopsy vs. Absence of Aschoff bodies was evaluated on Late mortality (p=0.043). The incidental finding of Aschoff bodies in myocardial and valvular biopsies during cardiac surgery predicted increased late mortality (22.9% vs 5.4%) over a 10-year follow-up.

synapsesocial.com/papers/6a45ac4c45fd8cfa32f829e1 https://doi.org/10.3390/diagnostics13203252

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Incidental Diagnosis of Rheumatic Myocarditis during Cardiac Surgery—Impact on Late Prognosis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Incidental Diagnosis of Rheumatic Myocarditis during Cardiac Surgery—Impact on Late Prognosis

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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