TY - JOUR
T1 - Neurological and Psychiatric Disorders in Patients with Rheumatic Heart Disease
T2 - Unveiling what is Beyond Cardiac Manifestations
AU - Vasconcelos, Luiz Paulo Bastos
AU - da Silva Bastos Vasconcelos, Marcelle Cristina
AU - Di Flora, Francisco Biagio Murta E.
AU - de Oliveira, Flávio Augusto Paes
AU - Lima, Pedro Drummond
AU - Silva, Lucas Campos Barbosa E.
AU - Spolaor, Breno Camargos Mucelli
AU - da Silva, José Luiz Padilha
AU - de Magalhães Esteves, William Antônio
AU - Nunes, Maria Carmo P.
AU - Teixeira, Antônio Lúcio
N1 - Publisher Copyright:
© 2022 Elsevier B.V.. All rights reserved.
PY - 2022
Y1 - 2022
N2 - Background: Rheumatic heart disease (RHD) is the most serious manifestation of rheumatic fever, which may also affect the brain. The current study assessed the prevalence of neuropsychiatric manifestations in patients with RHD, including clinical features associated with basal ganglia motor dysfunction (BGMD). Methods: We conducted neurologic and psychiatric assessments in consecutive patients with RHD referred to a tertiary center for heart valve diseases. Echocardiography was performed to assess the pattern of valvular involvement and RHD severity. Validated questionnaires for the evaluation of cognition, depression, anxiety, and obsessive-compulsive symptoms (OCS) were applied. BGMD was clinically defined by the presence of hyperkinetic movement disorders. Results: Fifty patients with age of 43.2 ± 10.8 years, 84% female, were included. Mitral valve was affected in 47 patients (94%), and 21 of them (42%) also had aortic valve involvement. Chorea (22%), chronic tics (18%), OCS (48%), major depression (34%), generalized anxiety disorder (54%), cognitive complaints (66%), migraine (52%) and seizures (18%) were frequently reported. The factors associated with BGMD were age (p = 0.018), major depression (p = 0.013), and Yale-Brown Obsessive Compulsive (Y-BOCS) score (p = 0.011). The severity of heart disease was not associated with BGMD. Conclusions: Neuropsychiatric manifestations are frequent in RHD patients, which may persist up to three decades after acute rheumatic fever. Age, major depression and severity of OCS were independently associated with BGMD. These manifestations deserve a close attention of clinicians and researchers dealing with adult patients with RHD.
AB - Background: Rheumatic heart disease (RHD) is the most serious manifestation of rheumatic fever, which may also affect the brain. The current study assessed the prevalence of neuropsychiatric manifestations in patients with RHD, including clinical features associated with basal ganglia motor dysfunction (BGMD). Methods: We conducted neurologic and psychiatric assessments in consecutive patients with RHD referred to a tertiary center for heart valve diseases. Echocardiography was performed to assess the pattern of valvular involvement and RHD severity. Validated questionnaires for the evaluation of cognition, depression, anxiety, and obsessive-compulsive symptoms (OCS) were applied. BGMD was clinically defined by the presence of hyperkinetic movement disorders. Results: Fifty patients with age of 43.2 ± 10.8 years, 84% female, were included. Mitral valve was affected in 47 patients (94%), and 21 of them (42%) also had aortic valve involvement. Chorea (22%), chronic tics (18%), OCS (48%), major depression (34%), generalized anxiety disorder (54%), cognitive complaints (66%), migraine (52%) and seizures (18%) were frequently reported. The factors associated with BGMD were age (p = 0.018), major depression (p = 0.013), and Yale-Brown Obsessive Compulsive (Y-BOCS) score (p = 0.011). The severity of heart disease was not associated with BGMD. Conclusions: Neuropsychiatric manifestations are frequent in RHD patients, which may persist up to three decades after acute rheumatic fever. Age, major depression and severity of OCS were independently associated with BGMD. These manifestations deserve a close attention of clinicians and researchers dealing with adult patients with RHD.
KW - basal ganglia motor dysfunction
KW - migraine
KW - mood disorders
KW - obsessive-compulsive symptoms
KW - Rheumatic heart disease
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U2 - 10.5334/GH.1149
DO - 10.5334/GH.1149
M3 - Article
C2 - 36199561
AN - SCOPUS:85138535107
SN - 2211-8160
VL - 17
JO - Global Heart
JF - Global Heart
IS - 1
M1 - 62
ER -