Recurrence to persistence: Inflammatory markers in pediatric rheumatic heart disease
TL;DR
Pediatric RHD patients exhibit elevated blood inflammatory markers in the absence of acute rheumatic fever, and targeting this chronic inflammation could potentially slow progression of RHD.
Abstract
ABSTRACT Background: Studies in adults with chronic rheumatic heart disease (RHD) suggest persistence of elevated inflammatory markers, indicating a potential role of ongoing inflammation in disease chronicity. However, similar data in the pediatric population are lacking. Methods: A cross-sectional observational study was conducted in the Division of Pediatric Cardiology at a tertiary care hospital in North India from August 2022 to February 2024. Forty-three patients with RHD <18 years were enrolled. Comprehensive history taking and clinical examinations were conducted. Blood samples were collected to evaluate C-reactive protein (CRP), neutrophil-to-lymphocyte ratio, interleukin-6 (IL-6), IL-17, and tumor necrosis factor alpha (TNF-α) levels. Inflammatory marker levels were compared with American College of Cardiology (ACC) valvular heart disease (VHD) stage. Results: Mean age of participants was 13.14 ± 3.17 years. Mean duration of disease was 3.23 ± 1.98 years. The CRP was elevated in 37.2% (n = 16) patients. IL-6, IL-17, and TNF-α were elevated in all patients. IL-6 (P = 0.036) and IL-17 (P = 0.008) showed significant association with ACC VHD stage. Conclusions: Pediatric RHD patients exhibit elevated blood inflammatory markers in the absence of acute rheumatic fever. Targeting this chronic inflammation could potentially slow progression of RHD.