Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies

Abstract

This systematic review and meta-analysis aimed to provide a contemporaneous estimate of the global burden of rheumatic heart disease (RHD) from echocardiographic population-based studies. We searched multiple databases between January 01, 1996 and October 17, 2017. Random-effect meta-analysis was used to pool data. We included 82 studies (1,090,792 participant) reporting data on the prevalence of RHD and 9 studies on the evolution of RHD lesions. The pooled prevalence of RHD was 26.1‰ (95%CI 19.2–33.1) and 11.3‰ (95%CI 7.2–16.2) for studies which used the World Heart Federation (WHF) and World Health Organization (WHO) criteria, respectively. The prevalence of RHD varied inversely with the level of a country’s income, was lower with the WHO criteria compared to the WHF criteria, and was lowest in South East Asia. Definite RHD progressed in 7.5% (95% CI 1.5–17.6) of the cases, while 60.7% (95% CI 42.4–77.5) of cases remained stable over the course of follow-up. The proportion of cases borderline RHD who progressed to definite RHD was 11.3% (95% CI 6.9–16.5). The prevalence of RHD across WHO regions remains high. The highest prevalence of RHD was noted among studies which used the WHF diagnostic criteria. Definite RHD tends to progress or remain stable over time.

Echocardiographic screening to determine progression of latent rheumatic heart disease in endemic areas: A systematic review and meta-analysis

“…The progression of latent RHD was reported in 9 studies and was 11% (95% CI 6-16) in total, 6% (95% CI 1-11%) using non-WHF criteria and 15% (11)(12)(13)(14)(15)(16)(17)(18)(19)(20) using the 2012 WHF criteria ( Fig 2) for the entire cohort over the duration of the study (follow up range 5.7-90 months). The heterogeneity of reported prevalence was high between all studies (I 2 = 84.5%, P<0.001).…”

“…Given one of the fundamental requirements in evaluating a screening test is to determine whether early pathologic changes are progressive, [19] we aimed to systematically review and synthesise studies which report on the progression of latent valvular lesions. There have been two previously published meta-analyses examining the prevalence of rheumatic heart disease is endemic countries, [7] [20] including one with a section on progression of latent RHD. [20] Our search was conducted approximately 1.5 years later and includes additional cohorts.…”

“…There have been two previously published meta-analyses examining the prevalence of rheumatic heart disease is endemic countries, [7] [20] including one with a section on progression of latent RHD. [20] Our search was conducted approximately 1.5 years later and includes additional cohorts. [12,21,22] We also present an annualised rate of progression of latent and borderline RHD and comparison with controls.…”

Experimental Rodent Models of Cardiovascular Diseases

“…Due to the impact of medical conditions and living environment, rheumatic heart disease still has a high incidence in developing countries. The new meta-analysis from WHO data illustrated that the prevalence of rheumatic heart disease was 11.3%, and ~2% of deaths from cardiovascular disease are related to rheumatic heart disease ( 43 ). In Africa, South Asia, and many other regions, the high mortality rate of rheumatic heart disease cannot be ignored ( 44 ).…”

Pulmonary hypertension: From an orphan disease to a global epidemic

“…Fortunately, pulmonary hypertension is a curable and reversible condition, particularly with valve replacement or valvuloplasty. It is estimated that RHDs affect 33.4 million people globally, and cause 319,400 deaths 179–182 . Thus, we estimate that up to 3 to 10 million patients may have some form of pulmonary vascular complications secondary to rheumatic heart diseases.…”