Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening

Marijon, Éloi; Ou, Phalla; Celermajer, David S.; Ferreira, Béatriz; Mocumbi, Ana Olga; Jani, Dinesh; Pascal, Christophe; Jacob, Sophie; Sidi, Daniel; Jouven, Xavier

doi:10.1056/nejmoa065085

Cited by 650 publications

(553 citation statements)

References 12 publications

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“…No increased frequency of valvular abnormalities was observed. The value of a sensitive tool for the detection of valvular disease is underlined by the findings of recent studies in ARF, which showed that echocardiographic screening resulted in a considerably higher reported prevalence of rheumatic heart disease (almost 10 times as high) compared with clinical screening (23,24). Thus far, there are reports of the use of echocardiography only in small case series of patients with poststreptococcal ReA, with limited followup periods (12,13).…”

Section: Discussionmentioning

confidence: 99%

No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis

Bemmel

Delgado

Holman

et al. 2009

Arthritis & Rheumatism

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Objective. Poststreptococcal reactive arthritis (ReA) is a (poly)arthritis presenting after a Streptococcus group A infection. Acute rheumatic fever (ARF), albeit caused by the same pathogen, has different risk characteristics and is considered to be a separate entity. Whereas ARF is known to cause carditis, the risk of carditis in adult poststreptococcal ReA is unknown. Consequently, the prevailing recommendations regarding long-term antibiotic prophylaxis in poststreptococcal ReA are imprecise and derived from the data on ARF. This study was undertaken to investigate the development of valvular heart disease in an unselected cohort of adult patients with poststreptococcal ReA who did not receive antibiotic prophylaxis and were followed up prospectively.Methods. All patients presenting with early arthritis to an inception cohort of >2,000 white patients were evaluated. Patients presenting with poststreptococcal ReA (n ‫؍‬ 75) were selected. After a median followup of 8.9 years, the occurrence of valvular heart disease was evaluated by transthoracic echocardiography in 60 patients. Controls were matched for age, sex, body surface area, and left ventricular function, with a patient-tocontrol ratio of 1:2.Results. No differences were seen in left ventricular dimensions. Morphologic abnormalities of the mitral or aortic valves were not more prevalent among patients than among controls. Mild mitral regurgitation was present in 23% and 21% of patients and controls, respectively. Mild aortic regurgitation was present in 10% and 11%, and mild tricuspid regurgitation in 43% and 39%, respectively, revealing no significant differences.Conclusion. Our findings indicate that there is no increased risk of valvular heart disease in adult poststreptococcal ReA. Based on these data, routine longterm antibiotic prophylaxis is not recommended in adult poststreptococcal ReA.

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Section: Discussionmentioning

confidence: 99%

No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis

Bemmel

Delgado

Holman

et al. 2009

Arthritis & Rheumatism

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“…In 2015, the age‐standardized prevalence of RHD in endemic countries was 444/100 000 inhabitants,3 and the inclusion of latent disease found in screening programs4, 5, 6 may increase this rate. Echocardiography is the most sensitive screening tool for early detection of latent RHD, identifying 10 times more subclinical disease when compared with auscultation 7, 8. In 2012, the World Heart Federation published a consensus document with standardized echocardiographic criteria, and screening studies have followed them since 9…”

Section: Introductionmentioning

confidence: 99%

Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study

Nascimento

Sable

Nunes

et al. 2018

JAHA

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BackgroundConsidering the limited accuracy of clinical examination for early diagnosis of rheumatic heart disease (RHD), echocardiography has emerged as an important epidemiological tool. The ideal setting for screening is yet to be defined. We aimed to evaluate the prevalence and pattern of latent RHD in schoolchildren (aged 5–18 years) and to compare effectiveness of screening between public schools, private schools, and primary care centers in Minas Gerais, Brazil.Methods and ResultsThe PROVAR (Rheumatic Valve Disease Screening Program) study uses nonexperts and portable and handheld devices for RHD echocardiographic screening, with remote interpretation by telemedicine, according to the 2012 World Heart Federation criteria. Compliance with study consent and prevalence were compared between different screening settings, and variables associated with RHD were analyzed. In 26 months, 12 048 students were screened in 52 public schools (n=10 901), 2 private schools (n=589), and 3 primary care centers (n=558). Median age was 12.9 years, and 55.4% were girls. Overall RHD prevalence was 4.0% borderline (n=486) and 0.5% definite (n=63), with statistically similar rates between public schools (4.6%), private schools (3.5%), and primary care centers (4.8%) (P=0.24). The percentage of informed consents signed was higher in primary care centers (84.4%) and private schools (66.9%) compared with public schools (38.7%) (P<0.001). Prevalence was higher in children ≥12 years (5.3% versus 3.1%; P<0.001) and girls (4.9% versus 4.0%; P=0.02). Only age (odds ratio, 1.12; 95% confidence interval, 1.09–1.17; P<0.001) was independently associated with RHD.Conclusions RHD screening in primary care centers seems to achieve higher coverage rates. Prevalence among schoolchildren is significantly high, with rates higher than expected in private schools of high‐income areas. These data are important for the formulation of public policies to confront RHD.

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“…Given the prevalence of congenital heart disease in rural populations, multiple international studies [8,11,13,14] Beaton et al [14,15] compared auscultation with protocolized echocardiography in sub-Saharan Africa. This study showed a significantly higher burden of disease than expected which was attributed to the poor sensitivity of auscultation for identification of such pathology.…”

Section: Discussionmentioning

confidence: 99%

Feasibility study of first-year medical students identifying cardiac anatomy using ultrasound in rural Panama

Miner

Purdy

Curtis

et al. 2015

World Journal of Emergency Medicine

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BACKGROUND:There are over 15 million children who have cardiac anomalies around the world, resulting in a signifi cant morbidity and mortality. Early recognition and treatment can improve the outcomes and lengthen life-expectancy of these patients. The NIH and WHO have promoted guidelines for screening for congenital cardiac anomalies using ultrasound in rural environments. METHODS:Our study took place in Bocas Del Toro, Panama where a mobile clinic was established for community healthcare screening and ultrasonographic evaluation by medical student volunteers and volunteer clinical faculty. This was a non-blinded, investigational study utilizing a convenience sample of pediatric patients presenting for voluntary evaluation. Seven fi rst-year medical students were recruited for the study. These students underwent a training program for advanced cardiac ultrasound instruction, termed "Pediatric Echocardiography Cardiac Screening (PECS)". RESULTS:Ten patients were enrolled in the study. Nine patients had adequate images as defined by the PECS criteria and were all classified as normal cardiac pathology by the medical students, resulting in a sensitivity and specifi city of 100%. A single patient was identifi ed by medical students as having a pathologic pulmonic stenosis. This was confirmed as correct by a blinded ultrasonographer. CONCLUSIONS:In this pilot study, the first-year medical students were able to correctly identify pediatric cardiac anatomy and pathology in rural Panama after undergoing a 12-hour ultrasound PECS training session. We believe that with this knowledge, minimally trained practitioners can be used to screen for cardiac anomalies in rural Panama using ultrasound.

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Prevalence of Rheumatic Heart Disease Detected by Echocardiographic Screening

Cited by 650 publications

References 12 publications

No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis

No increased risk of valvular heart disease in adult poststreptococcal reactive arthritis

Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study

Feasibility study of first-year medical students identifying cardiac anatomy using ultrasound in rural Panama

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