scholarly journals Simplified echocardiographic screening criteria for rheumatic heart disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Kotit
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Structural Changes ◽  
Control Group ◽  
Healthy Children ◽  
Major Health Problem ◽  
Screening Programs ◽  
Significant Difference ◽  
Rheumatic Heart

Abstract Introduction Rheumatic Heart Disease (RHD) remains a major health problem in many low and middle-income countries. The paucity of systematic screening studies and differences in the diagnostic criteria might underestimate greatly the reported prevalence rates. The standardized WHF criteria is the gold standard for the echocardiographic diagnosis of RHD. Keeping in mind the setting and the implementation of screening programs which require screening of large groups of individuals with limited resources, we have developed a simplified protocol for the swift recognition of RHD features (Image 1). Purpose Validation of a simplified protocol for the echocardiographic diagnosis of RHD in endemic areas based on screening and follow-up of a large sample of school children in comparison with the WHF criteria. Methods A systematic cross-sectional echocardiographic screening was performed in 3062 randomly selected schoolchildren, aged 5 to 15 years. Follow-up of 72 children with a definite or possible diagnosis of RHD together with a control group of 80 healthy children was carried over 48 to 60 months. The diagnosis of RHD was based on the current WHF criteria and compared to the simplified protocol (Image 2). Results Based on the WHF criteria 60 children were diagnosed with definite RHD (19.6/1000) vs 75 (24.5/1000) and 35 with possible disease (11.4 per 1000) versus 41 (13.4/1000) with the simplified criteria. No significant differences were found in progression or regression rates between both criteria. The appearance of isolated structural changes in 7 controls (8.8%) would lead to borderline diagnosis in the simplified criteria. Conclusion There is no significant difference in progression and regression rates between both criteria. Importantly, the simplified criteria would diagnose 7 children from the control group as possible RHD, which could show the accuracy of the criteria in diagnosing subtle valvular lesions. FUNDunding Acknowledgement Type of funding sources: None. Image 1. Simplified RHD criteria Image 2. Progress of RHD based on criteria

scholarly journals Relationship between Environmental Factors and Rheumatic Heart Disease

2021 ◽  
Vol 9 (B) ◽  
pp. 1795-1798
Author(s):  
Tina Christina Lumban Tobing ◽  
Teddy Ontoseno ◽  
Sri Rahayuningsih ◽  
Ratna Akbari Ganie ◽  
Yahwardiah Siregar
Keyword(s):  
High School ◽  
Heart Disease ◽  
Environmental Factors ◽  
Rheumatic Heart Disease ◽  
Junior High School ◽  
Junior High ◽  
Meat Consumption ◽  
Control Group ◽  
Healthy Children ◽  
Rheumatic Heart

Background. Rheumatic fever (RF) and rheumatic heart disease (RHD) are the most common acquired heart diseases in children. Environmental factors have been reported to play an important role in RHD’s prevalence Aim. The main purpose of this study is to assess the associations between environmental factors and RHD in children. Methods. A case control study was conducted in the Department of Child Health, Haji Adam Malik Hospital from April to June 2017. The case group consisted of children aged 5-18 years with RHD while control group consisted of healthy children. Demographic, anthropometric, and laboratory data were collected along with environmental factors. Statistical analysis was done using Statistical Product and Service Solution (SPSS). A P value of <0,05 with 95% confidence interval was considered significant. Results. A total of 39 children were enrolled in each group. Subjects’ father who only went to elementary and junior high school had a higher risk of having children with RHD (OR 28; p = 0.032 and OR 15.75; p = 0.011, respectively). Subjects’ mother who only went to junior high school had 7 times higher risk of having children with RHD (p = 0.026). Low monthly income increased the risk of RHD (OR 3,68; p = 0,009). Tap water usage, meat consumption more than once per week, and feasibility to buy clothes >1 pair per year decreased the risk of RHD at 0,31 (p = 0,013), 0,3 (p = 0,016), and 0,04 times (p <0,001) respectively. Conclusion. Parent’s education, monthly family income, water source, frequency of meat consumption, and feasibility to buy clothes are related to RHD in children.

scholarly journals Rheumatic heart disease among Omani schoolchildren

1997 ◽  
Vol 3 (1) ◽  
pp. 17-23
Author(s):  
Aly A. Hasab ◽  
Ali Jaffer ◽  
Abdulla M. Riyami
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
School Health ◽  
Primary Health Care System ◽  
Primary Health ◽  
Significant Difference ◽  
And Control ◽  
Rheumatic Heart

Screening of 9904 Omani schoolchildren from different regions in Oman gave a prevalence rate of rheumatic heart disease of 8 per 10 000 with no significant difference by sex or level of education. Follow-up of the sample for three months gave an estimated annual incidence of rheumatic fever of 4 per 10 000. The positive predictive value of definite murmurs for diagnosis of cardiovascular disease was 35.21% for school health physicians and 86.67% for regional physicians. The results show that rheumatic fever and rheumatic heart disease are not major public health problems in Oman. The study recommends integration of the management and control of the diseases within the primary health care system

225 Rheumatic heart disease in Timor Leste school students (RHD-TL) follow-up study: assessment of secondary prophylaxis and outcomes in Timor Leste

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A Horton ◽  
B Remenyi ◽  
K Davis ◽  
N Mock ◽  
E Paratz ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Secondary Prophylaxis ◽  
Penicillin G ◽  
School Students ◽  
Borderline Cases ◽  
Follow Up Study ◽  
Timor Leste ◽  
Rheumatic Heart

Abstract Background The Rheumatic Heart disease in Timor Leste school students (RHD-TL) study identified Timor Leste as having some of the highest rates of definite rheumatic heart disease (RHD) in the world. The RHD-TL follow-up study aimed to assess the delivery and outcomes of the secondary prophylaxis program in known patients with echocardiographic screen detected definite and borderline RHD. Methods School-students in Timor Leste where reassessed over a 3-year period since the initial study in 2016. Prospective assessments included adherence to secondary prophylaxis, complications of prophylaxis, follow-up clinical assessment and serial echocardiography. Of the 48 patients, 25 Definite and 23 Borderline, 38 (79%) of all patients, and 92% of definite RHD cases have had one or more follow-up assessments including full datasets for adherence, recurrence rates and progression of disease. Follow-up is provided by the volunteer paediatric cardiology team and rheumatic heart disease team of two NGOs in collaboration with local clinics. Results The median duration of follow-up of the 38 patients was of 1.6 years. The median age was 13 years (range 8-22) and 75% were female. Adherence rates in patients with definite RHD was on average greater than 95% during the follow-up period. Of the 23 patients with mild or moderate RHD one case with documented acute rheumatic fever (ARF) recurrence progressed whilst 8 cases improved on benzathine-penicillin G (BPG) therapy. There was no progression of the 6 borderline cases who were not prescribed BPG. Out of the 9 borderline cases in whom BPG was prescribed, one, with 67% adherence, had a documented episode of ARF leading to echocardiographic progression and moderate definite RHD. Conclusion This was the first follow-up study to look at disease natural history, both in treated and untreated groups, in Timor-Leste and brought practical insights into the efficacy of the Timor Leste RHD monitoring and prophylaxis programs. Its ongoing project will enable advocacy and quality assessment for the program as it expands. Abstract 225 Figure 1.

scholarly journals Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e036827 ◽  
Author(s):  
Bárbara Martins Bechtlufft ◽  
Bruno Ramos Nascimento ◽  
Craig Sable ◽  
Clara Leal Fraga ◽  
Márcia Melo Barbosa ◽  
...  
Keyword(s):  
Heart Disease ◽  
Public Schools ◽  
Rheumatic Heart Disease ◽  
Heart Diseases ◽  
Diagnostic Category ◽  
Secondary Outcome ◽  
Unfavourable Outcome ◽  
History Of ◽  
Rheumatic Heart

ObjectivesEchocardiographic (echo) screening is an important tool to estimate rheumatic heart disease (RHD) prevalence, but the natural history of screen-detected RHD remains unclear. The PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática) study, which uses non-experts, telemedicine and portable echo, pioneered RHD screening in Brazil. We aimed to assess the mid-term evolution of Brazilian schoolchildren (5–18 years) with echocardiography-detected subclinical RHD and to assess the performance of a simplified score consisting of five components of the World Heart Federation criteria, as a predictor of unfavourable echo outcomes.SettingPublic schools of underserved areas and private schools in Minas Gerais, southeast Brazil.ParticipantsA total of 197 patients (170 borderline and 27 definite RHD) with follow-up of 29±9 months were included. Median age was 14 (12–16) years, and 130 (66%) were woman. Only four patients in the definite group were regularly receiving penicillin.Primary and secondary outcome measuresUnfavourable outcome was based on the 2-year follow-up echo, defined as worsening diagnostic category, remaining with mild definite RHD or development/worsening of valve regurgitation/stenosis.ResultsAmong patients with borderline RHD, 29 (17.1%) progressed to definite, 49 (28.8%) remained stable, 86 (50.6%) regressed to normal and 6 (3.5%) were reclassified as other heart diseases. Among those with definite RHD, 13 (48.1%) remained in the category, while 5 (18.5%) regressed to borderline, 5 (18.5%) regressed to normal and 4 (14.8%) were reclassified as other heart diseases. The simplified echo score was a significant predictor of RHD unfavourable outcome (HR 1.197, 95% CI 1.098 to 1.305, p<0.001).ConclusionThe simple risk score provided an accurate prediction of RHD status at 2-year follow-up, showing a good performance in Brazilian schoolchildren, with a potential value for risk stratification and monitoring of echocardiography-detected RHD.

scholarly journals Platelet-leukocyte aggregate is associated with adverse events after surgical intervention for rheumatic heart disease

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Chaonan Liu ◽  
Yang Yang ◽  
Lei Du ◽  
Si Chen ◽  
Jie Zhang ◽  
...  
Keyword(s):  
Heart Disease ◽  
Adverse Events ◽  
Rheumatic Heart Disease ◽  
Surgical Intervention ◽  
Vascular Lesions ◽  
Kaplan Meier ◽  
Rheumatic Valve Disease ◽  
Cox Proportional Hazard Regression ◽  
Rheumatic Heart

Abstract Platelet-leukocyte aggregate (PLA) is implicated in the etiology of both vascular lesions and cardiovascular events. This prospective cohort study aimed to examine the prognostic value of PLA for major adverse cardiac and cerebrovascular events (MACCE) and perioperative adverse events (AEs) in patients with rheumatic heart disease undergoing surgical intervention by Cox proportional hazard regression and logistic regression. A total of 244 patients were included, of whom 7 were lost to follow-up. Among the analyzed 237 subjects who completed 3-year follow-up, 30 experienced MACCE and 38 experienced perioperative AEs. Preoperative PLA was higher in subjects who developed MACCE (13.32%) than in those who did not (8.69%, p = 0.040). In multivariate regression, elevated PLA was associated with increased MACCE (hazard ratio 1.51 for each quartile, 95% CI 1.07–2.13; p = 0.020), and perioperative AEs (odds ratio 1.61, 95% CI 1.14–2.26; p = 0.007). The optimal PLA cut-off for predicting MACCE was 6.8%. Subjects with PLA > 6.8% had a higher prevalence of MACCE (17.1% vs. 5.5%, p = 0.009) and perioperative AEs (19.9% vs. 8.6%, p = 0.018). Kaplan-Meier analysis showed shorter MACCE-free survival in patients with PLA > 6.8% (p = 0.007, log rank). Elevated preoperative PLA is associated with increased MACCE and perioperative AEs in patients with rheumatic valve disease undergoing surgical intervention.

P3131Evolution of subclinical rheumatic heart disease: a multi-centre retrospective cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Sanyahumbi ◽  
G Karthikeyan ◽  
T Aliku ◽  
A Beaton ◽  
J Carapetis ◽  
...  
Keyword(s):  
Cohort Study ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Multivariable Analysis ◽  
Subtype C ◽  
Factors Associated ◽  
Rheumatic Heart

Abstract Background Screening echocardiography (echo) detects subclinical rheumatic heart disease (RHD) which is categorised as definite or borderline. The natural history of subclinical RHD is not known. Follow up single centre studies have included a relatively small number of participants, and have shown variable progression rates. Aim To determine incidence of and factors associated with progression and regression among a cohort of children with baseline subclinical RHD across multiple countries and regions. Methods This is a retrospective cohort study of RHD evolution in children with subclinical RHD. Study sites were Australia, Fiji, Malawi, New Zealand, and Uganda. Progression or regression was determined from echos obtained at baseline and most recent follow-up. Factors associated with echo progression or regression were identified using multivariable logistic regression. Results 482 participants (131 with definite, 351 with borderline subclinical RHD) from 5 countries were included (mean age 11.5 years, range 5–19 years). Mean follow up was 3.4 yrs (range 0.4–9.5 yrs). Of 482 participating children, 204 (42%) regressed. Among 131 children with definite lesions, 48 (37%) regressed to borderline or normal, and 83 (63%) remained definite. Among 351 children with borderline lesions, 39 (11.1%) progressed, 156 (44.4%) remained borderline, and 156 (44.4%) regressed to normal. World Heart Federation defines subcategories based on characteristics of affected valves. By subcategory, children with definite C (pathological aortic regurgitation and 2 morphologic characteristics of the aortic valve) and borderline A (at least 2 morphologic features of the mitral valve without pathologic mitral regurgitation or stenosis) were less likely to regress, and borderline A was more likely to progress. In univariable analysis, good adherence (>80%) to penicillin prophylaxis (BPG) was associated with more regression among all patients (definite + borderline) (OR 1.9, CI 1, 3.5; p=0.04) but this association did not remain significant after adjustment. With multivariable analysis, borderlines prescribed BPG was the only factor related to progression from borderline to definite (OR 4.1, CI 1.8, 9.3, p<0.01). Conclusion This is the largest reported subclinical RHD cohort followed to report outcomes. 42% of definite RHD regressed with subtype C more likely to regress. 11% of borderline RHD progressed. Borderline A was more likely to progress and less likely to regress. We have also identified that being prescribed BPG is associated with borderline progression. This is likely because children with more advanced borderline disease may be more likely to be prescribed BPG. This study highlights that RHD evolution is variable out to 3–4 years post echo detection. While borderline disease is likely, in some cases, to reflect the earliest change of RHD, how this should be monitored and whether it should be treated with BPG should be a priority for future prospective evaluation.

scholarly journals Hypermethylation of brain natriuretic peptide gene is associated with the risk of rheumatic heart disease

2017 ◽  
Vol 37 (1) ◽  
Author(s):  
Ni Li ◽  
Dawei Zheng ◽  
Lebo Sun ◽  
Huoshun Shi ◽  
Xiuying Zhu ◽  
...  
Keyword(s):  
Heart Disease ◽  
Brain Natriuretic Peptide ◽  
Rheumatic Heart Disease ◽  
Natriuretic Peptide ◽  
Anticoagulant Therapy ◽  
Significant Difference ◽  
Term Administration ◽  
Promoter Dna ◽  
Peptide Gene ◽  
Rheumatic Heart

To investigate the contribution of brain natriuretic peptide (BNP) promoter DNA methylation to the risk of rheumatic heart disease (RHD) and the influence of warfarin anticoagulant therapy on BNP methylation levels for RHD patients after surgery. BNP methylation levels were determined by bisulfite pyrosequencing from plasma samples of RHD patients compared with healthy controls. Several factors influencing the RHD patients were included like age, smoking and cholesterol levels. A fragment of five CG sites (CpG1–5) in the promoter region of BNP gene was measured. BNP gene hypermethylation was found in CpG4 and CpG5 in RHD patients compared with non-RHD controls. A significant difference was also observed between RHD patients with long-term administration of warfarin and RHD patients who had recently undergone an operation. Moreover, single CpG4 and CpG5 analysis revealed a significant increase in methylation levels in men. BNP gene body hypermethylation is associated with the risk of RHD, and also influenced by the warfarin anticoagulant therapy of RHD patients after surgery, which could represent novel and promising targets for therapeutic development.

scholarly journals The personal and clinical impact of screen-detected maternal rheumatic heart disease in Uganda: a prospective follow up study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Sonia Voleti ◽  
Emmy Okello ◽  
Meghna Murali ◽  
Rachel Sarnacki ◽  
Albert Majwala ◽  
...  
Keyword(s):  
Heart Disease ◽  
Social Determinants Of Health ◽  
Rheumatic Heart Disease ◽  
Social Determinants ◽  
Determinants Of Health ◽  
World Health ◽  
Medical Decision ◽  
Rheumatic Heart

Abstract Background Pre-existing maternal cardiac disease is a significant contributor to adverse maternal, fetal, and neonatal outcomes. In 2015–2017, our team conducted the first community-based study of maternal rheumatic heart disease (RHD) in sub-Saharan Africa and identified RHD in 88% of those with pre-existing heart disease. Here we conducted a follow up investigation of women previously identified with RHD, describing clinical and echocardiographic outcomes, identifying barriers to medical adherence and evaluating the personal impact of RHD. Methods A 2 week prospective follow up was completed at sites in Central and Eastern Uganda. Participants underwent a three-step mixed methods study comprising of 1) direct structured interview targeting clinical history and medication adherence, 2) echocardiogram to evaluate left-sided heart valves, and 3) semi-structured guideline interview to elicit personal impacts of RHD. Results The team evaluated 40 (80%) of the original 51 mothers with RHD at a median post-partum time of 2.5 years after delivery (IQR 0.5). Echocardiographic data showed improvement in nine women with the remaining 31 women showing stable echocardiographic findings. Adherence to Benzathine penicillin G (BPG) prophylaxis was poor, with 70% of patients either poorly adherent or non-adherent. Three major themes emerged from interviews: 1) social determinants of health (World Health Organization, Social determinants of health, 2019) negatively affecting healthcare, 2) RHD diagnosis negatively affecting female societal wellbeing, 3) central role of spouse in medical decision making. Conclusions Screening echocardiography can identify women with pre-existing rheumatic heart disease during pregnancy, but long-term follow-up in Uganda reveals adherence to medical care following diagnosis, including BPG, is poor. Additionally, mothers diagnosed with RHD may experience unintended consequences such as social stigmatization. As identification of occult RHD is critical to prevent adverse pregnancy outcomes, further research is needed to determine how to best support women who face a new diagnosis of RHD, and to determine the role of screening echocardiography in high-risk settings.

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