Geneviève Bertaina1, Bernard Rouchon2, Bertrand Huon2, Nina Guillot2, Corinne Robillard2, Baptiste Noël3, Marie Nadra4, Christophe Tribouilloy5, Eloi Marijon6, Xavier Jouven6, Mariana Mirabel7. 1. INSERMU970, Paris Cardiovascular Research Centre-PARCC, Paris, France. 2. Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie. 3. Centre Hospitalier Territorial, Nouméa, Nouvelle-Calédonie. 4. Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie; Centre Hospitalier Territorial, Nouméa, Nouvelle-Calédonie. 5. Department of Cardiology, University Hospital Amiens, Amiens, France. 6. INSERMU970, 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. 7. INSERMU970, 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. Electronic address: mariana.mirabel@inserm.fr.
Abstract
CONTEXT AND AIMS: The advent of systematic screening for rheumatic heart disease (RHD) by echocardiography in endemic regions has led to a new entity: borderline RHD. The pathogenicity and natural history of borderline RHD needs to be addressed. The aim of this study was to assess the outcomes of children detected by echocardiography as having borderline RHD. METHODS: Schoolchildren in 4th grade (i.e., aged 9-10years) who were prospectively echo-screened for RHD (2012-2014) in Nouméa, New Caledonia, were asked to participate. Children with borderline RHD according to consistent independent review by two cardiologists were included and followed-up in 2015. RESULTS: Among the 8684 schoolchildren screened, 49 were diagnosed with borderline RHD according to the Cardiologist clinically involved in the child's management plan. After independent review by two cardiologists, 25 children were consistently diagnosed with borderline RHD and included in the follow-up study. Overall, inter-observer agreement was moderate with diagnostic kappa values of 0.63 (95% CI 0.45-0.78). After a median follow-up of 23months (IQR (20.5-33.0), 15 children (60.0%) had stability of valvular lesions, 8 (32.0%) had normal findings according to the WHF criteria. Two children (8.0%) had definite RHD on the follow-up echocardiogram, but no clinical events or audible pathological murmur during the study period. No factor could be identified as prognostic of either stability or progression. CONCLUSIONS: Borderline RHD diagnosed by systematic screening in high-risk populations remains mostly unchanged at 2years follow-up. Diagnosis of borderline RHD may require two reviewers for consistency.
CONTEXT AND AIMS: The advent of systematic screening for rheumatic heart disease (RHD) by echocardiography in endemic regions has led to a new entity: borderline RHD. The pathogenicity and natural history of borderline RHD needs to be addressed. The aim of this study was to assess the outcomes of children detected by echocardiography as having borderline RHD. METHODS: Schoolchildren in 4th grade (i.e., aged 9-10years) who were prospectively echo-screened for RHD (2012-2014) in Nouméa, New Caledonia, were asked to participate. Children with borderline RHD according to consistent independent review by two cardiologists were included and followed-up in 2015. RESULTS: Among the 8684 schoolchildren screened, 49 were diagnosed with borderline RHD according to the Cardiologist clinically involved in the child's management plan. After independent review by two cardiologists, 25 children were consistently diagnosed with borderline RHD and included in the follow-up study. Overall, inter-observer agreement was moderate with diagnostic kappa values of 0.63 (95% CI 0.45-0.78). After a median follow-up of 23months (IQR (20.5-33.0), 15 children (60.0%) had stability of valvular lesions, 8 (32.0%) had normal findings according to the WHF criteria. Two children (8.0%) had definite RHD on the follow-up echocardiogram, but no clinical events or audible pathological murmur during the study period. No factor could be identified as prognostic of either stability or progression. CONCLUSIONS: Borderline RHD diagnosed by systematic screening in high-risk populations remains mostly unchanged at 2years follow-up. Diagnosis of borderline RHD may require two reviewers for consistency.
Authors: Luke D Hunter; Alfonso J K Pecoraro; Anton F Doubell; Mark J Monaghan; Guy W Lloyd; Carl J Lombard; Philip G Herbst Journal: Eur Heart J Open Date: 2021-12-27
Authors: Luke David Hunter; Mark Monaghan; Guy Lloyd; Carl Lombard; Alfonso Jan Kemp Pecoraro; Anton Frans Doubell; Philipus George Herbst Journal: Open Heart Date: 2020-11