Are minor echocardiographic changes associated with an increased risk of acute rheumatic fever or progression to rheumatic heart disease?

Rémond, Marc; Atkinson, David; White, Andrew; Brown, Alex; Carapetis, Jonathan R.; Reményi, Bo; Roberts, Kathryn L.; Maguire, Graeme

doi:10.1016/j.ijcard.2015.07.005

Cited by 53 publications

(55 citation statements)

References 21 publications

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“…A single participant with borderline disease would have been classified as normal using the WHF definitions for individuals aged >20 years (table 4), and still classified as improved (from definite RHD at baseline). Agreement between the reporting cardiologist was moderate, similar to reported in other studies 9 13. Since the diagnosis of the same reporter on both echocardiograms was used for analysis, the use of a single reporter is unlikely to have affected the results.…”

Section: Discussionsupporting

confidence: 80%

“…Many of the normal cases were adults classified using WHF definitions for individuals aged >20 years, which do not include the borderline category, and therefore the proportion with objective improvements in echocardiography may have been lower. Other studies using the WHF criteria, with shorter follow-up periods, have shown progression of borderline RHD cases in 16%–42% 11 13 26. Earlier follow-up studies used non-standardised criteria, and although not directly comparable, reported similar findings 27–29…”

Section: Discussionmentioning

confidence: 90%

“…These cases had been flagged as abnormal using older criteria or by other reporters, and are therefore not representative of all screen-negative cases. Other studies have shown that 1%–2% of cases with normal screening echocardiograms may develop definite RHD 13 26. This likely reflects the cumulative risk of developing RHD in a high-prevalence setting, and demonstrates that screening at a single age point in childhood will miss a proportion of cases that develop RHD in adolescence and early adulthood.…”

Section: Discussionmentioning

confidence: 97%

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Screening-detected rheumatic heart disease can progress to severe disease

et al. 2016

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Objectives Echocardiography is a sensitive test for rheumatic heart disease (RHD) screening; however the natural history of RHD detected on screening has not been established. We aimed to evaluate the progression of screening-detected RHD in Fiji. Methods All young people previously diagnosed with RHD through screening, with echocardiograms available for review, were eligible. All baseline echocardiograms were reported again. Participants underwent follow-up echocardiography. A paediatric cardiologist determined the diagnosis using the World Heart Federation criteria and assessed the severity of regurgitation and stenosis. Results Ninety-eight participants were recruited (mean age, 17 years; median duration of follow-up, 7.5 years). Two other children had died from severe RHD. Fourteen of 20 (70%) definite RHD cases persisted or progressed, including four (20%) requiring valve surgery. Four (20%) definite RHD cases improved to borderline RHD and two (10%) to normal. Four of 17 (24%) borderline cases progressed to definite RHD (moderate: 2; severe: 2) and two (12%) improved to normal. Four of the 55 cases reclassified as normal at baseline progressed to borderline RHD. Cases with a follow-up interval >5 years were more likely to improve (37% vs 6%, p=0.03). Conclusions The natural history of screening-detected RHD is not benign. Most definite RHD cases persist and others may require surgery or succumb. Progression of borderline cases to severe RHD demonstrates the need for monitoring and individualised consideration of prophylaxis. Robust health system structures are needed for follow-up and delivery of secondary prophylaxis if RHD screening is to be scaled up.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 97%

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Screening-detected rheumatic heart disease can progress to severe disease

et al. 2016

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“…Most studies have reported univariate associations of baseline variables with disease progression or persistence (often combining the two as a single outcome) 8. Morphological characteristics of the valve at the time of detection have been shown to be associated with disease progression,7 and overcrowding with persistence or progression 6. Use of secondary prophylaxis has not been shown to be protective in the published studies and was paradoxically, independently associated with progression in one study 7.…”

Section: Measuring Determinants Of Progressionmentioning

confidence: 99%

“…Morphological characteristics of the valve at the time of detection have been shown to be associated with disease progression,7 and overcrowding with persistence or progression 6. Use of secondary prophylaxis has not been shown to be protective in the published studies and was paradoxically, independently associated with progression in one study 7. One critical variable which has not been adequately evaluated as a predictor of progression in screening studies is the severity of regurgitation at baseline.…”

Section: Measuring Determinants Of Progressionmentioning

confidence: 99%