Mariana Mirabel1, Thomas Fauchier2, Raoul Bacquelin3, Muriel Tafflet3, Agnès Germain4, Corinne Robillard4, Bernard Rouchon4, Eloi Marijon5, Xavier Jouven5. 1. INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Cardiology & Development, Paris, France. Electronic address: mariana.mirabel@inserm.fr. 2. INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France; Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie. 3. INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France. 4. Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie. 5. INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Cardiology & Development, Paris, France.
Abstract
OBJECTIVE: The objective of this study is to assess the outcomes of rheumatic heart disease (RHD) diagnosed by means of echocardiography-based screening. METHODS: A cohort of children with and with no RHD was driven from a systematic echocardiography-based nationwide surveillance among 4th grade (age 9-10 years) schoolchildren in South-Pacific New Caledonia (2008-2011). The specific follow-up programme used clinical and standardised echocardiography (2012 World Heart Federation criteria) predefined endpoints. RESULTS: Out of the 17,633 children screened, 157 were detected with findings of RHD. Among them, 114 consented children (76.5%) were enrolled (RHD-group), and were compared to 227 randomly selected healthy classmates (non-RHD group). After a median follow-up period of 2.58 years [1.31-3.63], incidence of acute rheumatic fever was similar in RHD and non-RHD groups (p=0.23): 10.28/1000/year and 3.31/1000/year, respectively. By echocardiography, 90 children in the RHD group (78.9%) still presented with RHD at follow-up, compared to 31 (13.7%) in the non-RHD group (p<0.0001). Only 12 children (10.5%) experienced progression of RHD over time, mild single valve disease lesions remaining unchanged in the majority of cases (61 out of 73, 83.6%). Overcrowded living conditions were independently associated with persistent RHD on echocardiography (OR 8.27 95% CI (1.67-41.08), p<0.01). Benzathine penicillin G was given in 88.6% of children in the RHD-group. CONCLUSIONS: Children screened positive for RHD by echocardiography have mostly mild but irreversible heart valve disease under secondary prophylaxis. Our findings also suggest that a single screening point in childhood may prove insufficient in high-risk populations.
OBJECTIVE: The objective of this study is to assess the outcomes of rheumatic heart disease (RHD) diagnosed by means of echocardiography-based screening. METHODS: A cohort of children with and with no RHD was driven from a systematic echocardiography-based nationwide surveillance among 4th grade (age 9-10 years) schoolchildren in South-Pacific New Caledonia (2008-2011). The specific follow-up programme used clinical and standardised echocardiography (2012 World Heart Federation criteria) predefined endpoints. RESULTS: Out of the 17,633 children screened, 157 were detected with findings of RHD. Among them, 114 consented children (76.5%) were enrolled (RHD-group), and were compared to 227 randomly selected healthy classmates (non-RHD group). After a median follow-up period of 2.58 years [1.31-3.63], incidence of acute rheumatic fever was similar in RHD and non-RHD groups (p=0.23): 10.28/1000/year and 3.31/1000/year, respectively. By echocardiography, 90 children in the RHD group (78.9%) still presented with RHD at follow-up, compared to 31 (13.7%) in the non-RHD group (p<0.0001). Only 12 children (10.5%) experienced progression of RHD over time, mild single valve disease lesions remaining unchanged in the majority of cases (61 out of 73, 83.6%). Overcrowded living conditions were independently associated with persistent RHD on echocardiography (OR 8.27 95% CI (1.67-41.08), p<0.01). Benzathine penicillin G was given in 88.6% of children in the RHD-group. CONCLUSIONS:Children screened positive for RHD by echocardiography have mostly mild but irreversible heart valve disease under secondary prophylaxis. Our findings also suggest that a single screening point in childhood may prove insufficient in high-risk populations.
Authors: Daniel Engelman; Gavin R Wheaton; Reapi L Mataika; Joseph H Kado; Samantha M Colquhoun; Bo Remenyi; Andrew C Steer Journal: Heart Asia Date: 2016-11-28
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Authors: Liesl Zühlke; Mark E Engel; Carolina E Lemmer; Marnie van de Wall; Simpiwe Nkepu; Alet Meiring; Michael Bestawros; Bongani M Mayosi Journal: BMC Cardiovasc Disord Date: 2016-02-19 Impact factor: 2.298