Spectrum and severity of rheumatic valve disease: echocardiographic findings from a high-burden region in eastern indonesia

Abstract Background Rheumatic heart disease (RHD) remains a major contributor to valvular heart disease morbidity in low- and middle-income countries, with Indonesia among the highest-burden nations. Eastern Indonesia, in particular, experiences a disproportionately high prevalence due to limited access to early diagnosis and treatment. Echocardiography is essential for assessing valvular involvement and guiding timely management, yet regional data remain scarce. Methods A retrospective, descriptive observational study was conducted at a tertiary referral center in Eastern Indonesia. Medical records of patients diagnosed with RHD between January 2020 and December 2022 were reviewed. Valvular abnormalities were classified by type and severity using standard echocardiographic criteria. Left ventricular systolic function was assessed via left ventricular ejection fraction (LVEF), and right ventricular function was measured using tricuspid annular plane systolic excursion (TAPSE). Results Among 100 patients with confirmed RHD, mitral regurgitation was the most common lesion, observed in 61 patients (33%)—including 12 mild, 11 moderate, and 38 severe cases. Mitral stenosis was the second most prevalent (52 patients, 28.1%), with 29 classified as severe. Aortic regurgitation occurred in 39 patients (21.1%). Less common lesions included aortic stenosis (5 patients, 2.7%) and tricuspid regurgitation (13 patients, 7%). Pulmonary and tricuspid stenosis were rare, and no cases of pulmonary stenosis were identified. Despite extensive valvular involvement, LVEF was ≥ 50% in 86% of patients, and TAPSE was ≥ 1.7 cm in 69%,indicating generally preserved biventricular systolic function. Conclusion Among RHD patients in Eastern Indonesia, severe mitral valve lesions—particularly regurgitation—predominate. Despite the high burden of valvular disease, most patients demonstrated preserved left and right ventricular systolic function. These findings underscore the ongoing impact of RHD in this region and reaffirm the importance of echocardiography in early diagnosis, clinical monitoring, and treatment planning.