The Relationship Between Clinical Characteristics and Types of Valvular Lesions With the Severity of Rheumatic Heart Disease

Rheumatic Heart Disease (RHD) is a preventable chronic valvular disorder caused by recurrent Acute Rheumatic Fever, yet remains a major issue in developing countries. This study aimed to assess the relationship between clinical characteristics, valvular lesion types, and RHD severity in patients at Dr. Soetomo General Hospital, Surabaya. This research is an analytical observational cross-sectional study was conducted using secondary medical record data of RHD patients at Pusat Pelayanan Jantung Terpadu (PPJT), Dr. Soetomo General Hospital. A total of 183 patients were included, consisting of 18 with mild-to-moderate RHD and 165 with severe RHD. Data on age, sex, cardiovascular symptoms, NYHA functional class, ECG findings, and types of valvular lesions were analyzed using Chi-square, Fisher’s Exact Test, and ordinal logistic regression. The analysis results show most patients (90.2%) had severe RHD. Mitral stenosis (p = 0.002), tricuspid stenosis/regurgitation (p = 0.012), and pulmonary stenosis/regurgitation (p = 0.003) were significantly associated with RHD severity. ECG findings of atrial fibrillation/flutter also showed a strong correlation (p < 0.01). In the multivariate model, pulmonary stenosis/regurgitation showed a protective effect (p = 0.029; coefficient = –2.345), while atrial fibrillation/flutter increased the likelihood of severe disease (p = 0.012; coefficient = 1.578). The research conclusion is that atrial arrhythmia independently increased the likelihood of severe RHD, whereas pulmonary valve lesions showed an inverse statistical association, suggesting different pathophysiological contributions of electrical and right-sided valvular involvement to RHD severity.