Pediatric Cardiology

, Volume 34, Issue 3, pp 583–590 | Cite as

Prediction of Residual Valvular Lesions in Rheumatic Heart Disease: Role of Adhesion Molecules

  • Mona Hafez
  • Sohier Yahia
  • Waleed Eldars
  • Heba Eldegla
  • Mohamed Matter
  • Gehan Attia
  • Samia Hawas
Original Article
First Online:
Received:
Accepted:

Abstract

Rheumatic heart disease (RHD) is a chronic condition characterized by fibrosis and scarring of the cardiac valves and damage to the heart muscle, leading to congestive heart failure and death. This prospective cohort study was conducted to investigate the possible relation between the levels of serum adhesion molecules and acute rheumatic fever (ARF) carditis, valvular insult severity, and residual valvular lesion after improvement of rheumatic activity. Serum levels of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin were assayed by enzyme-linked immunoassay (ELISA) for 50 children with ARF carditis during activity and after improvement and for 50 healthy children as control subjects. After the acute attack, patients were followed up regularly to detect residual valvular lesion. The serum levels of these adhesion molecules were significantly higher in the patients than in the control group (p < 0.001). In addition, the levels of serum adhesion molecules were significantly higher in the patients with severe carditis than in the patients with mild to moderate carditis (p < 0.001). Among the severe carditis group, the level of serum adhesion molecules was significantly higher among the patients with heart failure than among the patients without heart failure (p < 0.001). Furthermore, the pretreatment serum levels of ICAM-1 and VCAM-1 were significantly higher among the patients with residual valve lesion (p = 0.002) than among those without the lesion (p < 0.001). The cutoff values were obtained for the prediction of residual valvular lesion (ICAM-1, >1,032.3 μg/ml; VCAM-1, >3,662.3 μg/ml; E-selectin, >104.8 μg/ml). Finally, by combining the three adhesion molecules in a single prediction model, the highest area under the curve (AUC) ± standard error (SE) was obtained (0.869 ± 0.052), and the positive likelihood ratio for having a residual valvular lesion was increased (17.33). Levels of serum adhesion molecules could predict residual valvular lesions in RHD patients. The authors recommend that the serum level of adhesion molecules be measured in all cases of ARF carditis.

Keywords

Adhesion molecule Rheumatic heart disease Valvular lesion 
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References

  1. 1.
    Bloom BJ, Nelson SM, Eisenberg D, Alario AJ (2005) Soluble intercellular adhesion molecule-1 and E-selectin as markers of disease activity and endothelial activation in juvenile idiopathic arthritis. J Rheumatol 32:366–372PubMedGoogle Scholar
  2. 2.
    Carapetis JR, Steer AC, Mulholland EK, Weber M (2005) The global burden of group A streptococcal diseases. Lancet Infect Dis 5:685–694PubMedCrossRefGoogle Scholar
  3. 3.
    Carapetis JR, Brown A, Wilson NJ, Edwards KN (2007) An Australian guideline for rheumatic fever and rheumatic heart disease: an abridged outline. Med J Aust 186:581–586PubMedGoogle Scholar
  4. 4.
    Chen M-C, Chang H-W, Juang S-S, Yip H-K, Wu C-J, Yu T-H, Cheng C-I (2004) Percutaneous transluminal mitral valvuloplasty reduces circulating vascular cell adhesion molecule-1 in rheumatic mitral stenosis. Chest 25:1213–1217CrossRefGoogle Scholar
  5. 5.
    Chin TK (2010) Rheumatic heart disease. http://emedicine.medscape.com/article/891897-overview
  6. 6.
    Cunningham MW (1996) Streptococci and rheumatic fever. In: Rose NR, Friedman H (eds) Microorganisms and autoimmune disease. Plenum Publishing Corp, New York, pp 13–66CrossRefGoogle Scholar
  7. 7.
    Cunningham MW (2000) Pathogenesis of group A streptococcal infections. Clin Microbiol Rev 13:470–511PubMedCrossRefGoogle Scholar
  8. 8.
    Cunningham MW (2003) Autoimmunity and molecular mimicry in the pathogenesis of post-streptococcal heart disease. Frontiers Biosci 8:s533–s543CrossRefGoogle Scholar
  9. 9.
    Etzioni A (1994) Adhesion molecules in host defense. Clin Diagn Lab Immunol 1:1–4PubMedGoogle Scholar
  10. 10.
    Fyler DC (1992) Rheumatic fever. In: Fyler DC (ed) Nadas pediatric cardiology. Hanely and Belfus Inc, Philadelphia, p 305Google Scholar
  11. 11.
    Galvin JE, Hemric ME, Ward K, Cunningham MW (2000) Cytotoxic monoclonal antibody from rheumatic carditis reacts with human endothelium: implications in rheumatic heart disease. J Clin Invest 106:217–224PubMedCrossRefGoogle Scholar
  12. 12.
    Gearing AJ, Newman W (1993) Circulating adhesion molecules in disease. Immunol Today 14:506–512PubMedCrossRefGoogle Scholar
  13. 13.
    Gerber MA, Baltimore RS, Eaton CB, Gewitz M, Rowley AH, Shulman ST, Taubert KA (2009) Prevention of rheumatic fever and diagnosis and treatment of acute streptococcal pharyngitis: a scientific statement from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, the Interdisciplinary Council on Functional Genomics and Translational Biology, and the Interdisciplinary Council on Quality of Care and Outcomes Research. Endorsed by the American Academy of Pediatrics. Circulation 119:1541–1551PubMedCrossRefGoogle Scholar
  14. 14.
    Guilherme L, Ramasawmy R, Kalil J (2007) Rheumatic fever and rheumatic heart disease: genetics and pathogenesis. Scand J Immunol 66:199–207PubMedCrossRefGoogle Scholar
  15. 15.
    Gupta P, Chatterjee S, Agarwal AK, Singh VP, Arya V (2010) Rheumatic fever: a reappraisal. J Indian Acad Clin Med 11:99–106Google Scholar
  16. 16.
    Hafez M, EL-Morsy Z, EL-Shennawy F, Hawas S, Sheishaa A, AL-Marsafawy H, Abo-EL-Kheir M, Shokeir M, EL-Desoky T, EL-Deek B, Atia G, EL-Bakary G (2001) Cytokine gene expression in rheumatic fever. Egypt J Immunol 8:61–76Google Scholar
  17. 17.
    Hafez M, EL-Morsy Z, EL-Shennawy F, Hawas S, Sheishaa A, Abo-EL-Kheir M, Shokeir M, AL-Marsafawy H, EL-Baz R, Atia G (2002) Susceptibility to overproduction of cytokines in acute rheumatic carditis and their role in pathogenesis. J Med Sci 2:65–73CrossRefGoogle Scholar
  18. 18.
    Harlan JM, Liu DY (eds) (1992) Adhesion: its role in inflammatory disease. W.H. Freeman and Co., New YorkGoogle Scholar
  19. 19.
    Hebbar M, Lassalle P, Janin A, Vanhee D, Bisiau S, Hatron PY, Tonnel AB, Gosselin B (1995) E-selectin expression in salivary endothelial cells and sera from patients with systemic sclerosis. Arthritis Rheum 38:406–412PubMedCrossRefGoogle Scholar
  20. 20.
    Kemeny E, Grieve T, Marcus R, Zabriskie JB, Sareli P (1989) Identification of mononuclear cells and T cell subsets in rheumatic valvulitis. Clin Immunol Immunopathol 52:225–237PubMedCrossRefGoogle Scholar
  21. 21.
    Lee JL, Naguwa SM, Cheema GS, Gershwin ME (2009) Acute rheumatic fever and its consequences: a persistent threat to developing nations in the 21st century. Autoimmun Rev 9:117–123PubMedCrossRefGoogle Scholar
  22. 22.
    Pigot R, Power C (1993) The adhesion molecule facts book. Academic Press, San DiegoGoogle Scholar
  23. 23.
    Quinn RW (1989) Comprehensive review of morbidity and mortality trends for rheumatic fever, streptococcal disease, and scarlet fever: the decline of rheumatic fever. Rev Infect Dis 11:928–953PubMedCrossRefGoogle Scholar
  24. 24.
    Roberts S, Kosanke S, Dunn ST, Jankelow D, Duran CM, Cunningham MW (2001) Pathogenic mechanisms in rheumatic carditis: focus on valvular endothelium. J Infect Dis 183:507–511PubMedCrossRefGoogle Scholar
  25. 25.
    Sfikakis PP, Tsokos GC (1995) Lymphocyte adhesion molecules in autoimmune rheumatic diseases: basic issues and clinical expectations. Clin Exp Rheumatol 13:764–777Google Scholar
  26. 26.
    Sfikakis PP, Tsokos GC (1997) Clinical use of the measurement of soluble cell adhesion molecules in patients with autoimmune rheumatic diseases. Clin Diagn Lab Immunol 4:241–246Google Scholar
  27. 27.
    Shi-Wen X, Panesar M, Vancheeswaran R, Mason J, Haskard D, Black C, Olsen I, Abraham D (1994) Expression and shedding of intercellular adhesion molecule 1 and lymphocyte function-associated antigen 3 by normal and scleroderma fibroblasts: effects of interferon-gamma, tumor necrosis factor alpha, and estrogen. Arthritis Rheum 37:1689–1697PubMedCrossRefGoogle Scholar
  28. 28.
    Shulman ST, Kaplan EL, Bisno AL et al (1984) Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the American Heart Association. Circulation 70:204A–208AGoogle Scholar
  29. 29.
    Springer TA (1994) Traffic signals for lymphocyte recirculation and leukocyte emigration: the multistep paradigm. Cell 76:301–314PubMedCrossRefGoogle Scholar
  30. 30.
    Steer AC, Carapetis JR (2009) Acute rheumatic fever and rheumatic heart disease in indigenous populations. Pediatr Clin North Am 56:1401–1419PubMedCrossRefGoogle Scholar
  31. 31.
    Stollerman GH, Markowitz M, Taranta A, Wannamaker LW, Whittemore R (1965) Report of the ad hoc Committee on Rheumatic Fever and Congenital Heart Disease of American Heart Association: Jones’ criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 32:664–668CrossRefGoogle Scholar
  32. 32.
    Yaman IH, Dagdemir A, Baysal K (2003) Serum intercellular adhesion molecule-1 levels in acute rheumatic fever. Ann Trop Paediatr 23:167–171PubMedCrossRefGoogle Scholar
  33. 33.
    Yetkin E, Erbay AR, leri M, lTurhan H, Balci M, Cehreli S, Yetkin G, Demirkan D (2001) Levels of circulating adhesion molecules in rheumatic mitral stenosis. Am J Cardiol 88:1209–1211PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Mona Hafez
    • 1
  • Sohier Yahia
    • 1
  • Waleed Eldars
    • 2
  • Heba Eldegla
    • 2
  • Mohamed Matter
    • 1
  • Gehan Attia
    • 1
  • Samia Hawas
    • 2
  1. 1.Pediatric Department, Faculty of MedicineMansoura University Children’s HospitalMansouraEgypt
  2. 2.Medical Microbiology and Immunology Department, Mansoura Faculty of MedicineMansoura UniversityMansouraEgypt

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