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Latent Rheumatic Heart Disease: Outcomes 2 Years After Echocardiographic Detection

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Abstract

Screening with portable echocardiography has uncovered a large burden of latent rheumatic heart disease (RHD) among asymptomatic children in endemic regions, the significance of which remains unclear. This study aimed to determine the 2-year outcomes for children with latent RHD diagnosed by echocardiographic screening. Children identified with latent RHD enrolled in a biannual follow-up program. Risk factors for disease persistence and progression were examined. Of 62 children, 51 (82 %) with latent RHD had a median follow-up period of 25 months. Of these 51 children, 17 (33.3 %) reported an interval sore throat or symptoms consistent with acute rheumatic fever (ARF). Of 43 children initially classified as having borderline RHD, 21 (49 %) remained stable, 18 (42 %) improved (to no RHD) and 4 (10 %) worsened to definite RHD. Of the 8 children initially classified as having definite RHD, 6 (75 %) remained stable, and 2 (25 %) improved to borderline RHD. Two children had confirmed episodes of recurrent ARF, one of which represented the sole case of clinical worsening. The risk factors for disease persistence or progression included younger age (p = 0.05), higher antistreptolysin O titers at diagnosis (p = 0.05), and more morphologic valve abnormalities (p = 0.01). After 2 years, most of the children had a benign course, with 91 % remaining stable or showing improvement. Education may improve recognition of streptococcal sore throat. Longer-term follow-up evaluation, however, is warranted to confirm disease progression and risk factor profile. This could help tailor screening protocols for those at highest risk.

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References

  1. Beaton A, Okello E, Lwabi P, Mondo C, McCarter R, Sable C (2012) Echocardiography screening for rheumatic heart disease in Ugandan schoolchildren. Circulation 125:3127–3132

    Article  PubMed  Google Scholar 

  2. Bhaya M, Panwar S, Beniwal R, Panwar RB (2010) High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography 27:448–453

    Article  PubMed  Google Scholar 

  3. Bhaya M, Beniwal R, Panwar S, Panwar RB (2011) Two years of follow-up validates the echocardiographic criteria for the diagnosis and screening of rheumatic heart disease in asymptomatic populations. Echocardiography 28:929–933

    Article  PubMed  Google Scholar 

  4. Bland EF, Duckett Jones T (1951) Rheumatic fever and rheumatic heart disease; a twenty-year report on 1,000 patients followed since childhood. Circulation 4:836–843

    Article  CAS  PubMed  Google Scholar 

  5. Carapetis JR, Hardy M, Fakakovikaetau T, Taib R, Wilkinson L, Penny DJ, Steer AC (2008) Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren. Nat Clin Pract Cardiovasc Med 5:411–417

    Article  PubMed  Google Scholar 

  6. Feinstein AR, Spagnuolo M, Wood HF, Taranta A, Tursky E, Kleinberg E (1964) Rheumatic fever in children and adolescents: a long-term epidemiologic study of subsequent prophylaxis, streptococcal infections, and clinical sequelae: VI. Clinical features of streptococcal infections and rheumatic recurrences. Ann Intern Med 60(Suppl 5):68–86

    Article  PubMed  Google Scholar 

  7. Majeed HA, Yousof AM, Khuffash FA, Yusuf AR, Farwana S, Khan N (1986) The natural history of acute rheumatic fever in Kuwait: a prospective six year follow-up report. J Chron Dis 39(5):361–369

    Article  CAS  PubMed  Google Scholar 

  8. Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, Paquet C, Jacob S, Sidi D, Jouven X (2007) Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 357:470–476

    Article  CAS  PubMed  Google Scholar 

  9. Meira ZM, Goulart EM, Colosimo EA, Mota CC (2005) Long-term follow-up of rheumatic fever and predictors of severe rheumatic valvar disease in Brazilian children and adolescents. Heart 91:1019–1022

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  10. Mirabel M, Celermajer DS, Ferreira B, Tafflet M, Perier MC, Karam N, Mocumbi AO, Jani DN, Sidi D, Jouven X, Marijon E (2012) Screening for rheumatic heart disease: evaluation of a simplified echocardiography-based approach. Eur Heart J Cardiovasc Imaging 13:1024–1029

    Article  PubMed  Google Scholar 

  11. Paar JA, Berrios NM, Rose JD, Caceres M, Pena R, Perez W, Chen-Mok M, Jolles E, Dale JB (2010) Prevalence of rheumatic heart disease in children and young adults in Nicaragua. Am J Cardiol 105:1809–1814

    Article  PubMed Central  PubMed  Google Scholar 

  12. Pelajo CF, Lopez-Benitez JM, Torres JM, de Oliveira SK (2010) Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever. Pediatr Rheum Online J 8:22

    Article  Google Scholar 

  13. Remenyi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, Lawrenson J, Maguire G, Marijon E, Mirabel M, Mocumbi AO, Mota C, Paar J, Saxena A, Scheel J, Stirling J, Viali S, Balekundri VI, Wheaton G, Zuhlke L, Carapetis J (2012) World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease-an evidence-based guideline. Nat Rev Cardiol 9:297–309

    Article  PubMed  Google Scholar 

  14. Remenyi B, Carapetis J, Wyber R, Taubert K, Mayosi BM (2013) Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease. Nat Rev Cardiol 10:284–292

    Article  CAS  PubMed  Google Scholar 

  15. Roberts K, Colquhoun S, Steer A, Remenyi B, Carapetis J (2012) Screening for rheumatic heart disease: current approaches and controversies. Nat Rev Cardiol 10(1):49–58

    Article  PubMed  Google Scholar 

  16. Saxena A, Ramakrishnan S, Roy A, Seth S, Krishnan A, Misra P, Kalaivani M, Bhargava B, Flather MD, Poole-Wilson PP (2011) Prevalence and outcome of subclinical rheumatic heart disease in India: the RHEUMATIC [Rheumatic Heart Echo Utilisation and Monitoring Actuarial Trends in Indian Children] study. Heart 97:2018–2022

    Article  PubMed  Google Scholar 

  17. Tubridy-Clark M, Carapetis JR (2007) Subclinical carditis in rheumatic fever: a systematic review. Int J Cardiol 119:54–58

    Article  PubMed  Google Scholar 

  18. Webb RH, Wilson NJ, Lennon DR, Wilson EM, Nicholson RW, Gentles TL, O’Donnell CP, Stirling JW, Zeng I, Trenholme AA (2011) Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic. Cardiol Young 21:436–443

    Article  PubMed  Google Scholar 

  19. Yavuz T, Nisli K, Oner N, Dindar A, Aydogan U, Omeroglu RE, Ertugrul T (2008) Long-term follow-up results of 139 Turkish children and adolescents with rheumatic heart disease. Eur J Pediatr 167:1321–1326

    Article  PubMed  Google Scholar 

  20. Yilmazer MM, Oner T, Tavli V, Cilengiroglu OV, Guven B, Mese T, Vitrinel A, Devrim I (2012) Predictors of chronic valvular disease in patients with rheumatic carditis. Pediatr Cardiol 33:239–244

    Article  PubMed  Google Scholar 

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Acknowledgments

We thank the Uganda Heart Institute, its physicians, nurses, and support staff, which made this research possible. This project was supported by Award no. UL1TR000075 from the NIH National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Advancing Translational Sciences or the NIH.

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Authors and Affiliations

  1. Children’s National Medical Center, 111 Michigan Avenue NW, Washington, DC, USA

    Andrea Beaton, Robert McCarter & Craig Sable

  2. Uganda Heart Institute, Ward 1C, Kampala, Uganda

    Emmy Okello, Twalib Aliku, Sulaiman Lubega & Peter Lwabi

  3. Mulago Hospital, Ward 3C, Kampala, Uganda

    Charles Mondo

Authors
  1. Andrea Beaton
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  2. Emmy Okello
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  3. Twalib Aliku
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  4. Sulaiman Lubega
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  5. Peter Lwabi
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  6. Charles Mondo
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  7. Robert McCarter
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  8. Craig Sable
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Correspondence to Andrea Beaton.

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Beaton, A., Okello, E., Aliku, T. et al. Latent Rheumatic Heart Disease: Outcomes 2 Years After Echocardiographic Detection. Pediatr Cardiol 35, 1259–1267 (2014). https://doi.org/10.1007/s00246-014-0925-3

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  • DOI: https://doi.org/10.1007/s00246-014-0925-3

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