Marc Rémond1, David Atkinson2, Andrew White3, Alex Brown4, Jonathan Carapetis5, Bo Remenyi6, Kathryn Roberts6, Graeme Maguire7. 1. James Cook University, Cairns, QLD, Australia. Electronic address: marc.remond@my.jcu.edu.au. 2. Rural Clinical School of Western Australia, The University of Western Australia, Broome, WA, Australia. 3. James Cook University, Townsville, QLD, Australia. 4. South Australian Health and Medical Research Institute, Adelaide, SA, Australia. 5. Telethon Kids Institute, University of Western Australia, Perth, WA, Australia. 6. Menzies School of Health Research, Darwin, NT, Australia. 7. Baker IDI Heart and Diabetes Institute, Alice Springs, NT, Australia.
Abstract
BACKGROUND: The World Heart Federation criteria for the echocardiographic diagnosis of rheumatic heart disease (RHD) include a category "Borderline" RHD which may represent the earliest evidence of RHD. We aimed to determine the significance of minor heart valve abnormalities, including Borderline RHD, in predicting the future risk of acute rheumatic fever (ARF) or RHD. METHODS: A prospective cohort study of Aboriginal and Torres Strait Islander children aged 8 to 18 years was conducted. Cases comprised children with Borderline RHD or other minor non-specific valvular abnormalities (NSVAs) detected on prior echocardiography. Controls were children with a prior normal echocardiogram. Participants underwent a follow-up echocardiogram 2.5 to 5 years later to assess for progression of valvular changes and development of Definite RHD. Interval diagnoses of ARF were ascertained. RESULTS: There were 442 participants. Cases with Borderline RHD were at significantly greater risk of ARF (incidence rate ratio 8.8, 95% CI 1.4-53.8) and any echocardiographic progression of valve lesions (relative risk 8.19, 95% CI 2.43-27.53) than their Matched Controls. Cases with Borderline RHD were at increased risk of progression to Definite RHD (1 in 6 progressed) as were Cases with NSVAs (1 in 10 progressed). CONCLUSIONS: Children with Borderline RHD had an increased risk of ARF, progression of valvular lesions, and development of Definite RHD. These findings provide support for considering secondary antibiotic prophylaxis or ongoing surveillance echocardiography in high-risk children with Borderline RHD.
BACKGROUND: The World Heart Federation criteria for the echocardiographic diagnosis of rheumatic heart disease (RHD) include a category "Borderline" RHD which may represent the earliest evidence of RHD. We aimed to determine the significance of minor heart valve abnormalities, including Borderline RHD, in predicting the future risk of acute rheumatic fever (ARF) or RHD. METHODS: A prospective cohort study of Aboriginal and Torres Strait Islander children aged 8 to 18 years was conducted. Cases comprised children with Borderline RHD or other minor non-specific valvular abnormalities (NSVAs) detected on prior echocardiography. Controls were children with a prior normal echocardiogram. Participants underwent a follow-up echocardiogram 2.5 to 5 years later to assess for progression of valvular changes and development of Definite RHD. Interval diagnoses of ARF were ascertained. RESULTS: There were 442 participants. Cases with Borderline RHD were at significantly greater risk of ARF (incidence rate ratio 8.8, 95% CI 1.4-53.8) and any echocardiographic progression of valve lesions (relative risk 8.19, 95% CI 2.43-27.53) than their Matched Controls. Cases with Borderline RHD were at increased risk of progression to Definite RHD (1 in 6 progressed) as were Cases with NSVAs (1 in 10 progressed). CONCLUSIONS:Children with Borderline RHD had an increased risk of ARF, progression of valvular lesions, and development of Definite RHD. These findings provide support for considering secondary antibiotic prophylaxis or ongoing surveillance echocardiography in high-risk children with Borderline RHD.
Authors: Julia Pereira Afonso Dos Santos; Gabriel Assis Lopes do Carmo; Andrea Zawacki Beaton; Tainá Vitti Lourenço; Adriana Costa Diamantino; Maria do Carmo Pereira Nunes; Craig Sable; Bruno Ramos Nascimento Journal: Arq Bras Cardiol Date: 2017-04 Impact factor: 2.000
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
Authors: Kathryn Roberts; Jeffrey Cannon; David Atkinson; Alex Brown; Graeme Maguire; Bo Remenyi; Gavin Wheaton; Elizabeth Geelhoed; Jonathan R Carapetis Journal: J Am Heart Assoc Date: 2017-03-02 Impact factor: 5.501