An echocardiographic appreciation of rheumatic heart disease: phenotypic variability of valvular involvement and its prognostic implications.

Abstract

Rheumatic heart disease (RHD) remains a major cause of cardiovascular morbidity and premature mortality in low- and middle-income countries. This review examines RHD from an echocardiographic perspective, emphasizing how valve-specific phenotypes, hemodynamic burden, and disease progression shape clinical presentation, prognosis, and management. The evolution of echocardiography, from M-mode and two-dimensional imaging to Doppler, strain, and three-dimensional techniques, has transformed understanding of rheumatic valve disease and established imaging as central to diagnosis, risk stratification, and therapeutic guidance. Rheumatic mitral stenosis, in particular, served as a model for the development of key echocardiographic principles in valve morphology, hemodynamics, and intervention planning. Beyond anatomical severity, physiological variables such as exercise-induced pulmonary pressure changes and net atrioventricular compliance provide important prognostic information and better reflect functional impairment. Across the spectrum of disease, echocardiography remains fundamental for early detection, phenotypic characterization, longitudinal surveillance, and individualized management of RHD.