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Culliford-Semmens N, Tilton E, Wilson N, Stirling J, Doughty R, Gentles T, Peat B, Dimalapang E, Webb R. Echocardiography for latent rheumatic heart disease in first degree relatives of children with acute rheumatic fever: Implications for active case finding in family members. EClinicalMedicine 2021; 37:100935. [PMID: 34386737 PMCID: PMC8343257 DOI: 10.1016/j.eclinm.2021.100935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/30/2021] [Accepted: 05/13/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Individuals with Acute Rheumatic Fever (ARF) often report a family history of ARF or Rheumatic Heart Disease (RHD) however the degree of familial susceptibility to RHD is poorly defined. This study aimed to determine RHD prevalence among first degree relatives of ARF patients using echocardiography. METHODS Children with ARF were recruited from Auckland, New Zealand. Parents and siblings ≥ 4years were offered echocardiography. Echocardiograms were reported according to World Heart Federation 2012 criteria. RHD prevalence in first degree relatives was compared to previously established population rates in the region. FINDINGS In total, 70 index cases with ARF were recruited. Echocardiography was performed in 94 parents and 132 siblings. There were 3 siblings with definite RHD and 9 with borderline RHD. There were 4 parents with definite RHD. Overall prevalence of RHD (definite and borderline) in siblings was 90/1,000 (95% CI 45-143/1,000) compared to 36/1,000 (95% CI 30-42/1,000) in New Zealand children from high ARF incidence populations (p 0.001). Prevalence of definite RHD in parents was 42/1,000 (95% CI 7-87/1,000) compared to 22/1,000 (95% CI 9-36/1,000) in adults from a high ARF incidence New Zealand population (p 0.249). INTERPRETATION RHD prevalence in siblings and parents of ARF cases is significantly greater than in comparable background populations. The contribution of hereditary versus environmental risk factors remains uncertain. We recommend targeted echocardiographic case-finding among siblings and parents of ARF/RHD cases in order to detect previously unrecognized latent RHD.
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Affiliation(s)
- Nicola Culliford-Semmens
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, New Zealand
| | - Elizabeth Tilton
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, New Zealand
| | - Nigel Wilson
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, New Zealand
| | - John Stirling
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, New Zealand
| | - Robert Doughty
- Department of Medicine, University of Auckland, New Zealand
| | - Thomas Gentles
- Department of Paediatric and Congenital Cardiac Services, Starship Children's Hospital, New Zealand
| | - Briar Peat
- Department of Medicine, University of Auckland, New Zealand
- Middlemore Hospital, Counties Manukau District Health Board, New Zealand
| | - Eliazar Dimalapang
- Green Lane Cardiovascular Services, Auckland District Health Board, New Zealand
| | - Rachel Webb
- KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand
- Department of Paediatric Infectious Diseases, Starship Children's Hospital, New Zealand
- Department of Paediatrics: Child and Youth Health, University of Auckland, New Zealand
- Corresponding author at: KidzFirst Children's Hospital, Counties Manukau District Health Board, New Zealand.
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Choudhary D, Panwar SR, Gupta BK, Panwar RB, Gupta R, Bhaya M, Beniwal R, Raja Panwar V, Sharma A, Gupta J, Nanda NC. Prevalence and follow-up of subclinical rheumatic heart disease among asymptomatic school children in a north-western district of India based on the World Heart Federation echocardiographic criteria. Echocardiography 2021; 38:1173-1178. [PMID: 34047381 DOI: 10.1111/echo.15035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/21/2021] [Accepted: 02/28/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The present study is based on the World Heart Federation (WHF) echocardiographic criteria to assess the prevalence of subclinical rheumatic heart disease (RHD) and elucidate evolution of the disease when the cases were placed on appropriate antibiotic prophylaxis and regular follow-up. The prevalence of subclinical RHD reported by previous active surveillance studies among asymptomatic school children is not comparable to our study because of major differences in screening methods. METHODS A random inclusion strategy was adopted to recruit urban and rural school children of Bikaner district in the state of Rajasthan, India. The diagnosis of RHD was based on the echocardiographic criteria proposed by the WHF. All studies were reported on-site by a single experienced cardiologist and the digitally preserved studies were reported by a second cardiologist off-site. The final diagnosis was made by consensus. The second echocardiogram was performed for cases diagnosed with RHD after two years from start of study to document early evolution of the disease with ongoing antibiotic prophylaxis. RESULTS A high prevalence of subclinical RHD was observed in the study population. Pathological mitral and/or aortic valve regurgitation was the commonest lesion, and a significant proportion of cases improved while on regular antibiotic prophylaxis. No case showed fixity of leaflets/ stenosis. CONCLUSION The prevalence of subclinical RHD is high in the study population, and the disease seems to regress over time in the presence of appropriate antibiotic prophylaxis.
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Affiliation(s)
- Dinesh Choudhary
- Department of Cardiology, Sardar Patel Medical College, Bikaner, India
| | | | - Bal Kishan Gupta
- Department of Medicine, Sardar Patel Medical College, Bikaner, India
| | | | - Rajeev Gupta
- Consultant Medicine, Eternal Heart Care Center, Jaipur, India
| | - Maneesha Bhaya
- Consultant Cardiologist, Clinic Du Bon Pasteur, Rose Hill, Mauritius
| | | | | | - Arvind Sharma
- Rajasthan University of Health Sciences, Jaipur, India
| | | | - Navin C Nanda
- Cardiovascular Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Targeted investment needed to end rheumatic heart disease in Africa. LANCET GLOBAL HEALTH 2021; 9:e887-e888. [PMID: 33984297 DOI: 10.1016/s2214-109x(21)00215-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
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Vervoort D, Antunes MJ, Pezzella AT. Rheumatic heart disease: The role of global cardiac surgery. J Card Surg 2021; 36:2857-2864. [PMID: 33938579 DOI: 10.1111/jocs.15597] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/25/2021] [Accepted: 04/15/2021] [Indexed: 11/30/2022]
Abstract
Rheumatic heart disease (RHD) remains a neglected disease of poverty. While nearly eradicated in high-income countries due to timely detection and treatment of acute rheumatic fever, RHD remains highly prevalent in low- and middle-income countries (LMICs) and among indigenous and disenfranchised populations in high-income countries. As a result, over 30 million people in the world have RHD, of which approximately 300,000 die each year despite this being a preventable and treatable disease. In LMICs, such as in Latin America, sub-Saharan Africa, and Southeast Asia, access to cardiac surgical care for RHD remains limited, impacting countries' population health and resulting economic growth. Humanitarian missions play a role in this context but can only make a difference in the long term if they succeed in training and establishing autonomous local surgical teams. This is particularly difficult because these populations are typically young and largely noncompliant to therapy, especially anticoagulation required by mechanical valve prostheses, while bioprostheses have unacceptably high degeneration rates, and valve repair requires considerable experience. Devoted and sustained leadership and local government and public health cooperation and support with the clinical medical and surgical sectors are absolutely essential. In this review, we describe historical developments in the global response to RHD with a focus on regional, international, and political commitments to address the global burden of RHD. We discuss the surgical and clinical considerations to properly manage surgical RHD patients and describe the logistical needs to strengthen cardiac centers caring for RHD patients worldwide.
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Affiliation(s)
- Dominique Vervoort
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Manuel J Antunes
- Clinic of Cardiothoracic Surgery, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Luo T, Meng X. Clinico-pathological classification of rheumatic mitral valve damage and surgical strategy. J Thorac Dis 2021; 13:2933-2941. [PMID: 34164184 PMCID: PMC8182522 DOI: 10.21037/jtd-20-3456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background There is a lack of established pathological indications for rheumatic valve repair. Therefore, we summarized the pathological classifications of rheumatic heart diseases and their correlations with the surgical strategies. Methods This observational study enrolled patients with rheumatic heart diseases who underwent mitral valve repair (MVP) or replacement at our centre between January 2017 and January 2019. Mitral leaflet, mitral commissural, and sub-valvular apparatus were classified into three grades from mild to severe, according to their degree of pathological damage. Based on certain principles and the grade of mitral leaflet, mitral commissural, and sub-valvular apparatus damage, three pathological types were identified (types I to III), based on which all patients were classified. The features of each pathological type were summarised. Differences between the three pathological types were analysed using chi-square test of tendency. These data were used to propose a clinico-pathological classification of rheumatic mitral valve damage in Chinese patients. Results Of 398 patients, 284 (70%) underwent MVP for rheumatic mitral valve diseases. There were 58 type I (15%) patients in the study, all of whom underwent repair (repair rate, 100%). Preoperative moderate-to-severe regurgitation with mild pathological lesions was observed in 64% of these patients. In 260 type II (65%) patients, the repair rate was 76% (197/260); preoperative moderate-to-severe stenosis was observed in 88% of these patients. In 80 type III (20%) patients, the repair rate was 36% (29/80); the preoperative rates of extremely severe stenosis and moderate-to-severe regurgitation in these patients were 50% and 40%, respectively. Several preoperative parameters show the change in trend with the increase in the pathological classification severity. Conclusions Our clinico-pathological classification of rheumatic mitral valve damage is applicable to MVP. Considering that the classification principles are based on the possibility of mitral repair, it provides a phased and achievable target ratio for MVP and a principle of screening patients who should undergo rheumatic MVP.
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Affiliation(s)
- Tiange Luo
- Cardiac Valve Centre, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
| | - Xu Meng
- Cardiac Valve Centre, Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University-Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing, China
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Shrestha NR, Bruelisauer D, Uranw S, Mahato R, Sherpa K, Agrawal K, Rothenbühler M, Karki P, Pilgrim T. Mid-term outcome of children with latent rheumatic heart disease in eastern Nepal. Open Heart 2021; 8:openhrt-2021-001605. [PMID: 33820851 PMCID: PMC8030462 DOI: 10.1136/openhrt-2021-001605] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/19/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Systematic echocardiographic screening of children in regions with an endemic pattern of rheumatic heart disease allows for the early detection of valvular lesions suggestive of subclinical rheumatic heart disease. The natural course of latent rheumatic heart disease is, however, incompletely understood at this time. Methods We performed a prospective cohort study of children detected to have echocardiographic evidence of definite or borderline rheumatic heart disease according to the World Heart Federation Criteria. Results Among 53 children found to have definite (36) or borderline (17) rheumatic heart disease, 44 (83%) children underwent follow-up at a median of 1.9 years (IQR 1.1–4.5). The median age of the children was 11 years (IQR 9–14) and 34 (64.2%) were girls. Among children with definite rheumatic heart disease, 21 (58.3%) were adherent to secondary antibiotic prophylaxis, 7 (19.4%) were not, information on adherence was missing in 2 (5.6%) children and 6 (16.7%) were lost to follow-up. Regression of disease was observed in 10 children (27.8%), whereas 20 children (55.6%) had stable disease. Among children adherent to secondary prophylaxis, seven (33.3%) showed regression of disease. Among children with borderline disease, seven (41.2%) showed regression of disease, three (17.6%) progression of disease, four (23.5%) remained stable and three (17.6%) were lost to follow-up. On univariate analysis, we identified no predictors of disease regression, and no predictors for lost to follow-up or non-adherence with secondary antibiotic prophylaxis. Conclusion Definite rheumatic heart disease showed regression in one in four children. Borderline disease was spontaneously reversible in less than half of the children and progressed to definite rheumatic heart disease in one in five children. Trial registration number NCT01550068.
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Affiliation(s)
- Nikesh Raj Shrestha
- Department of Cardiology, Neuro Cardio and Multispeciality Hospital, Biratnagar, Nepal
| | | | - Surendra Uranw
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajan Mahato
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Kunjang Sherpa
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Krishna Agrawal
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Prahlad Karki
- Department of Internal Medicine and Cardiology, BP Koirala Institute of Health Sciences, Dharan, Nepal
| | - Thomas Pilgrim
- Department of Cardiology, University of Bern, Bern, Switzerland
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Karki P, Uranw S, Bastola S, Mahato R, Shrestha NR, Sherpa K, Dhungana S, Odutayo A, Gurung K, Pandey N, Agrawal K, Shah P, Rothenbühler M, Jüni P, Pilgrim T. Effectiveness of Systematic Echocardiographic Screening for Rheumatic Heart Disease in Nepalese Schoolchildren: A Cluster Randomized Clinical Trial. JAMA Cardiol 2021; 6:420-426. [PMID: 33471029 PMCID: PMC7818193 DOI: 10.1001/jamacardio.2020.7050] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Question Is echocardiographic screening of schoolchildren in regions with an endemic pattern of rheumatic heart disease followed by secondary antibiotic prophylaxis in children with evidence of subclinical rheumatic heart disease effective in reducing the prevalence of rheumatic heart disease? Findings This cluster randomized clinical trial found a nonstatistically significant lower prevalence of definite or borderline rheumatic heart disease in schools with echocardiographic screening 4 years after intervention compared with control schools with no previous screening. An auxiliary repeated cross-sectional analysis of experimental schools found a significant reduction in the odds of definite or borderline rheumatic heart disease. Meaning A lower prevalence of rheumatic heart disease in schools with prior echocardiographic screening warrants further study of the effectiveness of early detection and timely treatment of rheumatic heart disease in children and adolescents. Importance Echocardiographic screening allows for early detection of subclinical stages of rheumatic heart disease among children in endemic regions. Objective To investigate the effectiveness of systematic echocardiographic screening in combination with secondary antibiotic prophylaxis on the prevalence of rheumatic heart disease. Design, Setting, and Participants This cluster randomized clinical trial included students 9 to 16 years of age attending public and private schools in urban and rural areas of the Sunsari district in Nepal that had been randomly selected on November 17, 2012. Echocardiographic follow-up was performed between January 7, 2016, and January 3, 2019. Interventions In the experimental group, children underwent systematic echocardiographic screening followed by secondary antibiotic prophylaxis in case they had echocardiographic evidence of latent rheumatic heart disease. In the control group, children underwent no echocardiographic screening. Main Outcomes and Measures Prevalence of the composite of definite or borderline rheumatic heart disease according to the World Heart Federation criteria in experimental and control schools as assessed 4 years after intervention. Results A total of 35 schools were randomized to the experimental group (n = 19) or the control group (n = 16). After a median of 4.3 years (interquartile range [IQR], 4.0-4.5 years), 17 of 19 schools in the experimental group (2648 children; median age at follow-up, 12.1 years; IQR, 10.3-12.5 years; 1308 [49.4%] male) and 15 of 16 schools in the control group (1325 children; median age at follow-up, 10.6 years; IQR, 10.0-12.5 years; 682 [51.5%] male) underwent echocardiographic follow-up. The prevalence of definite or borderline rheumatic heart disease was 10.8 per 1000 children (95% CI, 4.7-24.7) in the control group and 3.8 per 1000 children (95% CI, 1.5-9.8) in the experimental group (odds ratio, 0.34; 95% CI, 0.11-1.07; P = .06). The prevalence in the experimental group at baseline had been 12.9 per 1000 children (95% CI, 9.2-18.1). In the experimental group, the odds ratio of definite or borderline rheumatic heart disease at follow-up vs baseline was 0.29 (95% CI, 0.13-0.65; P = .008). Conclusions and Relevance School-based echocardiographic screening in combination with secondary antibiotic prophylaxis in children with evidence of latent rheumatic heart disease may be an effective strategy to reduce the prevalence of definite or borderline rheumatic heart disease in endemic regions. Trial Registration ClinicalTrials.gov Identifier: NCT01550068
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Affiliation(s)
- Prahlad Karki
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Surendra Uranw
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Santosh Bastola
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Rajan Mahato
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Nikesh Raj Shrestha
- Department of Cardiology, Neuro Cardio and Multispeciality Hospital, Biratnagar, Nepal
| | - Kunjang Sherpa
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Sahadeb Dhungana
- Noble Medical College Teaching Hospital and Research Center, Biratnagar, Nepal
| | - Ayodele Odutayo
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Keshar Gurung
- Department of Cardiology, Neuro Cardio and Multispeciality Hospital, Biratnagar, Nepal
| | - Naveen Pandey
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Krishna Agrawal
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Prashant Shah
- Department of Internal Medicine and Cardiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | | | - Peter Jüni
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
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Ouali S, Ben Halima A, Chabrak S, Chettaoui R, Ben Halima M, Haggui A, Krichane S, Noureddine L, Marrakchi S, Charfeddine S, Hassine M, Sayahi K, Abbes Mohamed F, Nasraoui W, Ajmi H, Ben Miled M, Jebbari Z, Meghaieth MA, Allouche E, Mechmeche R, Zakhama L, Sdiri W, Ben Khalfallah A, Gharbi A, Milouchi S, Neji A, Antit S, Battikh K, Drissa M, Kaabachi S, Najar T, Tlili R, Chahbani I, Charfeddine H, Ben MM, Braham S, Maatouk F, Abdesselem S, Ayari M, Garbaa R, Hamrouni N, Mbarek D, Rekik H, Zaghdoudi H, Ayadi W, Baraket F, Ben Brahim K, Ben Romdhane M, Bousadia H, Brahim W, Mezri M, Guesmi A, Ounissi T, Kammoun S, Smati W, Tlili S, Zoughi K, Zemni J, Cheikh Bouhlel M, Islem S, Jemli R, Joulak A, Mzoughi K, Naanea H, Hached L, Hadrich M, Hmem M, Kacem S, Kammoun I, Othmani R, Ouerghi A, Abid S, Ennouri R, Haidar S, Heraiech S, Jammali M, Jarrar M, Riahi L, Trimech B, Azaiez MA, Azzouzi F, Ben Jemaa K, Ben Rejab O, Chrigui R, Wechtati W, Boughzela E, Jridi G, Bezdah L, Kraiem S, Drissa H, Ben Youssef S, Fehri W, Kachboura S, Gamra H, Kammoun S, Mourali MS, Addad F, Abid L. Epidemiological characteristics, management, and outcomes of atrial fibrillation in TUNISIA: Results from the National Tunisian Registry of Atrial Fibrillation (NATURE-AF). Clin Cardiol 2021; 44:501-510. [PMID: 33704830 PMCID: PMC8027580 DOI: 10.1002/clc.23558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Contemporary registries on atrial fibrillation (AF) are scare in North African countries. HYPOTHESIS In the context of the epidemiological transition, prevalence of valvular AF in Tunisia has decreased and the quality of management is still suboptimal. METHODS NATURE-AF is a prospective Tunisian registry, involving consecutive patients with AF from March 1, 2017 to May 31, 2017, with a one-year follow-up period. All the patients with an Electrocardiogram-documented AF, confirmed in the year prior to enrolment were eligible. The epidemiological characteristics and outcomes were described. RESULTS A total of 915 patients were included in this study, with a mean age of 64.3 ± 22 years and a male/female sex ratio of 0.93. Valvular AF was identified in 22.4% of the patients. The mean CHA2 DS2 VASC score in nonvalvular AF was 2.4 ± 1.6. Monotherapy with antiplatelet agents was prescribed for 13.8% of the patients. However, 21.7% of the subjects did not receive any antithrombotic agent. Oral anticoagulants were prescribed for half of the patients with a low embolic risk score. In 341 patients, the mean time in therapeutic range was 48.87 ± 28.69%. Amiodarone was the most common antiarrhythmic agent used (52.6%). During a 12-month follow-up period, 15 patients (1.64%) had thromboembolism, 53 patients (5.8%) had major hemorrhage, and 52 patients (5.7%) died. CONCLUSIONS NATURE-AF has provided systematic collection of contemporary data regarding the epidemiological and clinical characteristics as well as the management of AF by cardiologists in Tunisia. Valvular AF is still prevalent and the quality of anticoagulation was suboptimal.
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Affiliation(s)
| | - Afef Ben Halima
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | | | | | | | | | | | | | - Sonia Marrakchi
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | | | - Majed Hassine
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | | | | | | | | | | | | | | | - Lilia Zakhama
- La Marsa Internal Security Forces Hospital, La Marsa, Tunisia
| | | | | | | | | | - Ali Neji
- Ben Guerdane Hospital, Medenine, Tunisia
| | - Saoussen Antit
- La Marsa Internal Security Forces Hospital, La Marsa, Tunisia
| | | | | | | | | | - Rami Tlili
- University Hospital Center Mongi Slim, La Marsa, Tunisia
| | | | | | | | | | - Faouzi Maatouk
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | | | | | - Dorra Mbarek
- University Hospital Center Mongi Slim, La Marsa, Tunisia
| | | | | | | | | | | | | | | | | | | | - Ali Guesmi
- Mohamed Ben Sassi Hospital, Gabes, Tunisia
| | - Taha Ounissi
- Mohamed Taher Al Maamouri Hospital, Nabeul, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ikram Kammoun
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Wafa Fehri
- Hôpital Militaire Principal d'instruction de Tunis, Tunis, Tunisia
| | - Salem Kachboura
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
| | - Habib Gamra
- Fattouma Bourguiba University Hospital, Monastir, Tunisia
| | | | | | - Faouzi Addad
- Abderrahman Mami Pneumology and Phthisiology Hospital, Ariana, Tunisia
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Wyber R, Wade V, Anderson A, Schreiber Y, Saginur R, Brown A, Carapetis J. Rheumatic heart disease in Indigenous young peoples. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:437-446. [PMID: 33705693 DOI: 10.1016/s2352-4642(20)30308-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/06/2020] [Accepted: 09/16/2020] [Indexed: 01/17/2023]
Abstract
Indigenous children and young peoples live with an inequitable burden of acute rheumatic fever and rheumatic heart disease. In this Review, we focus on the epidemiological burden and lived experience of these conditions for Indigenous young peoples in Australia, New Zealand, and Canada. We outline the direct and indirect drivers of rheumatic heart disease risk and their mitigation. Specifically, we identify the opportunities and limitations of predominantly biomedical approaches to the primary, secondary, and tertiary prevention of disease among Indigenous peoples. We explain why these biomedical approaches must be coupled with decolonising approaches to address the underlying cause of disease. Initiatives underway to reduce acute rheumatic fever and rheumatic heart disease in Australia, New Zealand, and Canada are reviewed to identify how an Indigenous rights-based approach could contribute to elimination of rheumatic heart disease and global disease control goals.
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Affiliation(s)
- Rosemary Wyber
- The George Institute for Global Health, Newtown, NSW, Australia.
| | - Vicki Wade
- RHDAustralia, Menzies School of Health Research, Darwin, NT, Australia
| | - Anneka Anderson
- Tomaiora Research Group, University of Auckland, Auckland, New Zealand
| | - Yoko Schreiber
- Section of Infectious Diseases, University of Manitoba, Clinical Sciences Division, Northern Ontario School of Medicine, ON, Canada
| | | | - Alex Brown
- South Australian Health and Medical Research Institute, University of Adelaide, SA, Australia
| | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Perth Children's Hospital, Perth, WA, Australia
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Hammadah M, Ponce C, Sorajja P, Cavalcante JL, Garcia S, Gössl M. Point-of-care ultrasound: Closing guideline gaps in screening for valvular heart disease. Clin Cardiol 2020; 43:1368-1375. [PMID: 33174635 PMCID: PMC7724242 DOI: 10.1002/clc.23499] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/14/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A linear increase in the number of valvular heart disease is expected due to the aging population, yet most patients with severe valvular heart disease remain undiagnosed. HYPOTHESIS POCUS can serve as a screening tool for valvular heart disease. METHODS We reviewed the literature to assess the strengths and limitations of POCUS in screening and diagnosing valvular heart disease. RESULTS POCUS is an accurate, affordable, accessible, and comprehensive tool. It has a fast learning curve and can prevent unnecessary and more expensive imaging. Challenges include training availability, lack of simplified screening protocols, and reimbursement. Large scale valvular screening data utilizing POCUS is not available. CONCLUSION POCUS can serve as a screening tool and guide the management of patients with valvular heart disease. More data is needed about its efficacy and cost-effectiveness in the screening of patients with valvular heart disease.
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Affiliation(s)
- Muhammad Hammadah
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Christopher Ponce
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Paul Sorajja
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - João L. Cavalcante
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Santiago Garcia
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
| | - Mario Gössl
- Interventional Cardiology DepartmentMinneapolis Heart instituteMinneapolisMinnesotaUSA
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Passos LS, Nunes MCP, Zilla P, Yacoub MH, Aikawa E. Raising awareness for rheumatic mitral valve disease. Glob Cardiol Sci Pract 2020; 2020:e202026. [PMID: 33426043 PMCID: PMC7768627 DOI: 10.21542/gcsp.2020.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 11/02/2020] [Indexed: 11/17/2022] Open
Abstract
Rheumatic heart disease (RHD) is a major burden in low- to mid-income countries, where each year it accounts for over a million premature deaths associated with severe valve disease. Life-saving valve replacement procedures are not available to the majority of affected RHD patients, contributing to an increased risk of death in young adults and creating a devastating impact. In December 2017, a group of representatives of major cardiothoracic societies and industry, discussed the plight of the millions of patients who suffer from RHD. A comprehensive solution based on this global partnership was outlined in "The Cape Town Declaration on Access to Cardiac Surgery in the Developing World". The key challenge in controlling RHD is related to identification and removal of barriers to the translation of existing knowledge into policy, programs, and practice to provide high-quality care for patients with RHD. This review provides an overview on RHD by emphasizing the disease medical and economic burdens worldwide, risk factors, recent advance for early disease detection, and overall preventive strategies.
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Affiliation(s)
- Livia S.A. Passos
- The Center for Excellence in Vascular Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Maria Carmo P. Nunes
- Hospital das Clínicas e Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Peter Zilla
- University of Cape Town, Cape Town, South Africa
| | | | - Elena Aikawa
- The Center for Excellence in Vascular Biology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Kumar RK, Antunes MJ, Beaton A, Mirabel M, Nkomo VT, Okello E, Regmi PR, Reményi B, Sliwa-Hähnle K, Zühlke LJ, Sable C. Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association. Circulation 2020; 142:e337-e357. [PMID: 33073615 DOI: 10.1161/cir.0000000000000921] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.
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Beaton A, Kamalembo FB, Dale J, Kado JH, Karthikeyan G, Kazi DS, Longenecker CT, Mwangi J, Okello E, Ribeiro ALP, Taubert KA, Watkins DA, Wyber R, Zimmerman M, Carapetis J. The American Heart Association's Call to Action for Reducing the Global Burden of Rheumatic Heart Disease: A Policy Statement From the American Heart Association. Circulation 2020; 142:e358-e368. [PMID: 33070654 DOI: 10.1161/cir.0000000000000922] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Rheumatic heart disease (RHD) affects ≈40 million people and claims nearly 300 000 lives each year. The historic passing of a World Health Assembly resolution on RHD in 2018 now mandates a coordinated global response. The American Heart Association is committed to serving as a global champion and leader in RHD care and prevention. Here, we pledge support in 5 key areas: (1) professional healthcare worker education and training, (2) technical support for the implementation of evidence-based strategies for rheumatic fever/RHD prevention, (3) access to essential medications and technologies, (4) research, and (5) advocacy to increase global awareness, resources, and capacity for RHD control. In bolstering the efforts of the American Heart Association to combat RHD, we hope to inspire others to collaborate, communicate, and contribute.
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Abstract
Rheumatic heart disease (RHD) remains the most common cause of cardiovascular morbidity and mortality globally in children and young adults. This article focuses on prevention and management of RHD. Pregnancy can unmask previously undiagnosed RHD and poses high risk for mother and fetus. Management of anticoagulation is important. Definitive catheter and surgical intervention are the only treatments that can improve outcomes of patients with moderate or severe RHD. Access to intervention remains very limited in RHD endemic regions. There are ongoing global efforts to increase awareness, public policy adoption, and greater access to treatment.
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Affiliation(s)
- Craig Sable
- Cardiology, Children's National Hospital, 111 Michigan Avenue, Northwest, Washington, DC 20010, USA.
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Soesanto AM, Suastika LOS. Echocardiography Screening for Latent Rheumatic Heart Disease: What Can We Do in Indonesia? Front Surg 2020; 7:46. [PMID: 32974379 PMCID: PMC7466630 DOI: 10.3389/fsurg.2020.00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022] Open
Abstract
Rheumatic heart disease (RHD), a sequela of acute rheumatic fever (ARF), is a preventable disease but remains a significant health problem, especially in developing countries. It causes disability, poor quality of life, early mortality, and national economic burden. The World Heart Federation (WHF) aimed to achieve a 25% reduction in premature deaths from ARF and RHD among individuals aged <25 years by 2025. Primordial and primary prophylaxis of RHD is aimed to prevent the occurrence of ARF, while the goal of secondary and tertiary prophylaxis is to limit the progression and reduce the consequences of RHD. Early recognition of RHD is important for early prophylaxis strategies to inhibit any progression to advanced stages. In 2012, WHF introduced the latest echocardiographic criteria to recognize the early stage of RHD. This includes the evaluation of pathological regurgitation jet and morphological features of RHD based on 2D, color, and spectral Doppler criteria. In remote areas, portable echocardiography is preferable for RHD screening. Previous portable devices were only capable of producing 2D and color images. Hence, a simplified echocardiographic criterion without spectral Doppler evaluation is needed in selected areas. Indonesia is a developing country, an archipelago with a population of over 250 million. Currently, there are no data on ARF incidence and RHD prevalence nationwide. The only data available are the number of patients in advanced stages who came to referral centers for further management. The screening program has to be introduced in Indonesia as part of national RHD prophylaxis.
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Affiliation(s)
- Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Luh Oliva Saraswati Suastika
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Udayana University Hospital, Denpasar, Indonesia
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Nkereuwem E, Ige OO, Yilgwan C, Jobe M, Erhart A, Bode-Thomas F. Prevalence of rheumatic heart disease in North-Central Nigeria: a school-based cross-sectional pilot study. Trop Med Int Health 2020; 25:1408-1415. [PMID: 32799403 DOI: 10.1111/tmi.13477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To present epidemiological data on rheumatic heart disease (RHD), the most common acquired heart disease in children and young adults in low- and middle-income countries, for North-Central Nigeria. METHODS In this pilot study, we conducted clinical and echocardiography screening on a cross section of randomly selected secondary schoolchildren in Jos, North-Central Nigeria, from March to September 2016. For outcome classification into borderline or definite RHD, we performed a confirmatory echocardiography using the World Heart Federation criteria for those suspected to have RHD from the screening. RESULTS A total of 417 secondary schoolchildren were screened, of whom 247 (59.2%) were female. The median age was 14 years (IQR: 13-15). Clinical screening detected 8/417 children, whereas screening echocardiography detected 42/417 suspected cases of RHD. Definitive echocardiography confirmed 9/417 with RHD corresponding to a prevalence of 21.6 per 1000 (95% CI, 6.7-36.5). All but one of the confirmed RHD cases (8/9) were borderline RHD corresponding to a prevalence of 19.2 per 1000 (95% CI, 8.3-37.5) for borderline RHD and 2.4 per 1000 (95% CI, 0.1-13.3) for definite RHD. RHD was more common in boys and cardiac auscultation missed over 50% of the cases. CONCLUSIONS This study showed a high prevalence of RHD among secondary schoolchildren in North-Central Nigeria with a vast predominance of asymptomatic borderline lesions. Larger school-based echocardiography screening using portable or handheld echocardiography aimed at early detection of subclinical RHD should be adopted.
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Affiliation(s)
- Esin Nkereuwem
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Olukemi O Ige
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria.,College of Health Sciences, University of Jos, Jos, Nigeria
| | - Christopher Yilgwan
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria.,College of Health Sciences, University of Jos, Jos, Nigeria
| | - Modou Jobe
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Annette Erhart
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Fidelia Bode-Thomas
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria.,College of Health Sciences, University of Jos, Jos, Nigeria
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Ghamrawy A, Ibrahim NN, Abd El-Wahab EW. How accurate is the diagnosis of rheumatic fever in Egypt? Data from the national rheumatic heart disease prevention and control program (2006-2018). PLoS Negl Trop Dis 2020; 14:e0008558. [PMID: 32804953 PMCID: PMC7451991 DOI: 10.1371/journal.pntd.0008558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/27/2020] [Accepted: 07/02/2020] [Indexed: 01/10/2023] Open
Abstract
Rheumatic heart disease (RHD) as a chronic sequela of repeated episodes of acute rheumatic fever (ARF), remains a cause of cardiac morbidity in Egypt although it is given full attention through a national RHD prevention and control program. The present report reviews our experience with subjects presenting with ARF or its sequelae in a single RHD centre and describes the disease pattern over the last decade. A cross-sectional study was conducted in El-Mahalla RHD centre between 2006 and 2018. A total of 17014 individual were enrolled and evaluated. Diagnosis ARF was based on the 2015 revised Jones criteria and RHD was ruled in by echocardiography. The majority of the screened subjects were female (63.2%), in the age group 5-15 years (64.6%), rural residents (61.2%), had primary education (43.0%), and of low socioeconomic standard (50.2%). The total percentage of cases presenting with ARF sequelae was 29.3% [carditis/RHD (10.8%), rheumatic arthritis (Rh.A) (14.9%), and Sydenham's chorea (0.05%)]. Noticeably, 72% were free of any cardiac insult, of which 37.7% were victims of misdiagnoses made elsewhere by untrained practitioners who prescribed for them long term injectable long-acting penicillin [Benzathine Penicillin G (BPG)] without need. About 54% of the study cohort reported the occurrence of recurrent attacks of tonsillitis of which 65.2% underwent tonsillectomy. Among those who experienced tonsillectomy and/or received BPG in the past, 14.5% and 22.3% respectively had eventually developed RHD. Screening of family members of some RHD cases who needed cardiac surgery revealed 20.7% with undiagnosed ARF sequalae [RHD (56.0%) and Rh.A (52.2%)]. Upon the follow-up of RHD cases, 1.2% had improved, 98.4% were stable and 0.4% had their heart condition deteriorated. Misdiagnosis of ARF or its sequelae and poor compliance with BPG use may affect efforts being exerted to curtail the disease. Updating national guidelines, capacity building, and reliance on appropriate investigations should be emphasized. Since the genetic basis of RHD is literally confirmed, a family history of RHD warrants screening of all family members for early detection of the disease.
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Affiliation(s)
- Alaa Ghamrawy
- Department of Non-Communicable Diseases, Ministry of Health and Population, Cairo, Egypt
| | - Nermeen N. Ibrahim
- Department of Epidemiology, High Institute of Public Health, Alexandria University, Alexandria, Egypt
| | - Ekram W. Abd El-Wahab
- Department of Tropical Health, High Institute of Public Health, Alexandria University, Alexandria, Egypt
- * E-mail:
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Lilyasari O, Prakoso R, Kurniawati Y, Roebiono PS, Rahajoe AU, Sakidjan I, Harimurti GM. Clinical Profile and Management of Rheumatic Heart Disease in Children and Young Adults at a Tertiary Cardiac Center in Indonesia. Front Surg 2020; 7:47. [PMID: 32903397 PMCID: PMC7434961 DOI: 10.3389/fsurg.2020.00047] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/23/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: Rheumatic heart disease (RHD) remains a major public health issue affecting children and young adults in developing countries. This study aimed to evaluate the clinical characteristics, management, and reactivation of RHD among children and young adults. Patients and Methods: This was a hospital-based retrospective study conducted at the National Cardiovascular Center Harapan Kita, Indonesia; we retrieved relevant data from patients diagnosed with RHD between 2012 and 2018. Results: Two hundred and seventy-nine patients were diagnosed with rheumatic heart disease, of whom 108 were children (mean age of 12.02 ± 3.36 years) and 171 were young adults (mean age was 24.9 ± 3.84). RHD was more common in female than in male young adults (1.5:1). Hospitalization due to RHD complications such as congestive heart failure was seen in 11.11% of cases in children, while pulmonary hypertension was present in 19.95% young adult cases. Reactivation of RHD occurred in 17.2% (48/279) cases, significantly in children (p < 0.001). Overall, the mitral valve (either isolated or combined) was the organ most affected in children (39.13%) and young adults (44.81%). Isolated mitral regurgitation was more common in children (13/21, 61.9%), while isolated mitral stenosis was more common in young adults (19/47, 40.42%). There was a high rate of rheumatic tricuspid valve disease in all populations (193/279, 69.17%) and reported involvement of pulmonary regurgitation (46/279, 16.48%). Multivalve lesions were more common than single lesions in both groups, with a combination of mitral and tricuspid regurgitation the predominant type in children (32/43, 74.41%) and mixed mitral lesion and tricuspid regurgitation in young adults (22/72, 30.56%). We observed a significant occurrence of quadrivalve lesions in children (p = 0.039). Valve repair was more common in children (49.07%) and replacement in young adults (32.16%), with low in-hospital mortality. Compliance with secondary prophylaxis was a significant challenge. Conclusion: Chronic RHD often presented with complications of the disease or reactivation of rheumatic fever (RF). Inadequate treatment of RF/RHD leads to extensive valvular damage and consequent disabilities. Efforts toward active early diagnosis and prompt treatment of RF/RHD and effective preventive measures are essential.
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Affiliation(s)
- Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Radityo Prakoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Yovi Kurniawati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Poppy S Roebiono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Anna Ulfah Rahajoe
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Indriwanto Sakidjan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Ganesja M Harimurti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
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Okello E, Ndagire E, Atala J, Bowen AC, DiFazio MP, Harik NS, Longenecker CT, Lwabi P, Murali M, Norton SA, Omara IO, Oyella LM, Parks T, Pulle J, Rwebembera J, Sarnacki RJ, Spurney CF, Stein E, Tochen L, Watkins D, Zimmerman M, Carapetis JR, Sable C, Beaton A. Active Case Finding for Rheumatic Fever in an Endemic Country. J Am Heart Assoc 2020; 9:e016053. [PMID: 32750303 PMCID: PMC7792248 DOI: 10.1161/jaha.120.016053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 06/03/2020] [Indexed: 12/15/2022]
Abstract
Background Despite the high burden of rheumatic heart disease in sub-Saharan Africa, diagnosis with acute rheumatic fever (ARF) is exceedingly rare. Here, we report the results of the first prospective epidemiologic survey to diagnose and characterize ARF at the community level in Africa. Methods and Results A cross-sectional study was conducted in Lira, Uganda, to inform the design of a broader epidemiologic survey. Key messages were distributed in the community, and children aged 3 to 17 years were included if they had either (1) fever and joint pain, (2) suspicion of carditis, or (3) suspicion of chorea, with ARF diagnoses made by the 2015 Jones Criteria. Over 6 months, 201 children met criteria for participation, with a median age of 11 years (interquartile range, 6.5) and 103 (51%) female. At final diagnosis, 51 children (25%) had definite ARF, 11 (6%) had possible ARF, 2 (1%) had rheumatic heart disease without evidence of ARF, 78 (39%) had a known alternative diagnosis (10 influenza, 62 malaria, 2 sickle cell crises, 2 typhoid fever, 2 congenital heart disease), and 59 (30%) had an unknown alternative diagnosis. Conclusions ARF persists within rheumatic heart disease-endemic communities in Africa, despite the low rates reported in the literature. Early data collection has enabled refinement of our study design to best capture the incidence of ARF and to answer important questions on community sensitization, healthcare worker and teacher education, and simplified diagnostics for low-resource areas. This study also generated data to support further exploration of the relationship between malaria and ARF diagnosis in rheumatic heart disease/malaria-endemic countries.
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Affiliation(s)
| | - Emma Ndagire
- Uganda Heart InstituteKampalaUganda
- Children’s National HospitalWashingtonDC
| | | | - Asha C. Bowen
- Telethon Kids InstitutePerthWestern AustraliaAustralia
| | | | | | | | | | | | | | | | | | - Tom Parks
- London School of Hygiene & Tropical MedicineLondonUnited Kingdom
| | | | | | | | | | | | | | | | | | | | | | - Andrea Beaton
- Cincinnati Children's Hospital Medical CenterCincinnatiOH
- Cincinnati University School of MedicineCincinnatiOH
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Francis JR, Fairhurst H, Hardefeldt H, Brown S, Ryan C, Brown K, Smith G, Baartz R, Horton A, Whalley G, Marangou J, Kaethner A, Draper ADK, James CL, Mitchell AG, Yan J, Ralph A, Remenyi B. Hyperendemic rheumatic heart disease in a remote Australian town identified by echocardiographic screening. Med J Aust 2020; 213:118-123. [DOI: 10.5694/mja2.50682] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/23/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Joshua R Francis
- Menzies School of Health ResearchCharles Darwin University Darwin NT
- Royal Darwin Hospital Darwin NT
| | - Helen Fairhurst
- Menzies School of Health ResearchCharles Darwin University Darwin NT
| | | | - Shannon Brown
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Chelsea Ryan
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Kurt Brown
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Greg Smith
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | - Roz Baartz
- Top End Health ServiceManingrida Health Centre Maningrida NT
| | | | | | | | | | - Anthony DK Draper
- Centre for Disease ControlNorthern Territory Department of Health Darwin NT
| | - Christian L James
- Centre for Disease ControlNorthern Territory Department of Health Darwin NT
| | - Alice G Mitchell
- Menzies School of Health ResearchCharles Darwin University Darwin NT
| | - Jennifer Yan
- Menzies School of Health ResearchCharles Darwin University Darwin NT
- Royal Darwin Hospital Darwin NT
| | - Anna Ralph
- Menzies School of Health ResearchCharles Darwin University Darwin NT
| | - Bo Remenyi
- Royal Darwin Hospital Darwin NT
- NT Cardiac Darwin NT
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Gutman SJ, Shemesh E, Marwick TH, Taylor AJ. Echocardiographic screening to determine progression of latent rheumatic heart disease in endemic areas: A systematic review and meta-analysis. PLoS One 2020; 15:e0234196. [PMID: 32497088 PMCID: PMC7272083 DOI: 10.1371/journal.pone.0234196] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/20/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The World Health Organisation previously recommended routine screening in school-aged children in countries with a high prevalence of rheumatic heart disease (RHD); however, it is unclear if screening-detected (latent) valve disease will inevitably evolve to a pathological lesion. Understanding the natural history of latent RHD is essential prior to recommendation of screening in endemic areas. Studies documenting the progression of latent RHD have had contrasting conclusions about the pathogenicity of latent valvular lesions. This review provides estimates of rates of progression of latent RHD. METHODS AND FINDINGS In this systematic review and meta-analysis, we searched EMBASE, MEDLINE, Global Index Medicus, Africa Wide, Cochrane Database of Systematic Reviews and Global Health Database for studies published before April 30, 2019. Study data were extracted from all studies which reported follow-up data on progression of latent valve lesions. Studies with control cohorts were used to calculate comparative prevalence ratios. This study is registered with PROSPERO, number CRD42019119427. We identified 12 studies reporting follow-up data on latent RHD for 950 people in 9 countries. The estimated pooled prevalence rate for progression per year of latent RHD was 5%/year (95% CI 2-8). Eight studies reported on the progression of borderline latent RHD with an estimated pooled prevalence of 2%/year (95% CI 0-4). Three studies included control groups. There was a significant increase in the risk of progression of valvular disease in the latent group compared with controls (RR = 3.57 (95%CI = 1.65-7.70, P = 0.001). The overall risk of bias was low. Given most studies included penicillin administration we were unable to document the natural history of latent RHD. Furthermore, we were unable to perform a sensitivity analysis to determine the effect of administering penicillin prophylaxis on progression of valve disease given prescription of penicillin was not standardised. CONCLUSION Latent RHD has a slow rate of progression but it is significantly higher compared to controls, with definite latent RHD having a higher rate of progression compared with borderline latent disease. There are a massive number of individuals at risk for RHD in the developing world as well as logistical challenges of screening and delivering penicillin prophylaxis. The low rate of progression from untargeted screening may be an important consideration in resource-constrained environments.
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Affiliation(s)
- Sarah J. Gutman
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Elad Shemesh
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Thomas H. Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
| | - Andrew J. Taylor
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiology, The Alfred Hospital, Melbourne, Australia
- Monash University, Melbourne, Australia
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Chatard JC, Dubois T, Espinosa F, Kamblock J, Ledos PH, Tarpinian E, Da Costa A. Screening Rheumatic Heart Disease in 1530 New Caledonian Adolescents. J Am Heart Assoc 2020; 9:e015017. [PMID: 32336214 PMCID: PMC7428581 DOI: 10.1161/jaha.119.015017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
BACKGROUND In New Caledonia, a South Pacific archipelago whose inhabitants comprise Melanesians, Europeans/whites, Wallisians, Futunans, Polynesians, and Asians, the prevalence of rheumatic heart disease (RHD) is 0.9% to 1% at ages 9 and 10. It could be higher at the age of 16, but this remains to be verified. METHODS AND RESULTS A total of 1530 Melanesian, Métis, white, Wallisian, Futunan, Polynesian, and Asian adolescents benefited from a transthoracic echocardiogram. Definite or borderline RHD, nonrheumatic valve lesions, congenital heart defects, family and personal history of acute rheumatic fever, and socioeconomic factors were collected. The prevalence of cardiac abnormalities was 8.1%, made up of 4.1% RHD including 2.4% definite and 1.7% borderline RHD, 1.7% nonrheumatic valve lesions, and 2.3% congenital anomalies. In whites and Asians, there were no cases of RHD. RHD was higher in the Wallisian, Futunan, and Polynesian group (7.6%) when compared with Melanesians (5.3%) and Métis (2.9%). The number of nonrheumatic valve lesions was not statistically different in the different ethnicities. The prevalence of RHD was higher in adolescents with a personal history of acute rheumatic fever, in those living in overcrowded conditions, and in those whose parents were unemployed or had low‐income occupations, such as the farmers or manual workers. CONCLUSIONS RHD was 4 times higher in adolescents at age 16 than at ages 9 and 10 (4.1% versus 0.9%–1%). No cases of RHD were observed in whites and Asians. The determining factors were history of acute rheumatic fever and socioeconomic factors.
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Affiliation(s)
- Jean-Claude Chatard
- Inter-University Laboratory of Human Movement Science Faculty of Medicine Jacques Lisfranc University Lyon-Saint-Etienne Saint-Etienne France.,Directorate of Health and Social Affairs Noumea New Caledonia
| | - Thomas Dubois
- Department of Cardiology Faculty of Medicine Jacques Lisfranc University Lyon-Saint-Etienne Saint-Etienne France.,Directorate of Health and Social Affairs Noumea New Caledonia
| | - Florian Espinosa
- Department of Cardiology Faculty of Medicine Jacques Lisfranc University Lyon-Saint-Etienne Saint-Etienne France
| | | | | | | | - Antoine Da Costa
- Department of Cardiology Faculty of Medicine Jacques Lisfranc University Lyon-Saint-Etienne Saint-Etienne France
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73
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Ahmed K, Rehman Memon A, Liaquat H, Mujtaba M, Parkash C, Sultan FAT, Karim M. The Frequency of Left Atrial Thrombus on Transthoracic Echocardiogram in Patients with Mitral Stenosis. Cureus 2020; 12:e7453. [PMID: 32351832 PMCID: PMC7188021 DOI: 10.7759/cureus.7453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Patients with mitral stenosis (MS) are more prone to develop left atrial (LA) thrombus. This cross-sectional study was conducted to determine the frequency of LA thrombus on transthoracic echocardiography (TTE) in patients with MS. Methods In this study, we included patients diagnosed with MS undergoing TTE at the echocardiography department of the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. The severity of MS was classified based on the mitral valve area (MVA) as follows: very severe: MVA of ≤1.0 cm2; severe: MVA of ≤1.5 cm2; and mild to moderate: MVA of >1.5 cm2. The LA thrombus was observed and noted on TTE. Results A total of 256 MS patients were included in this study, out of which 46.5% (119) were male. The mean age was 33.78 ±11.51 years. MS was classified as mild to moderate in 3.5% of the patients, severe in 54.3%, and very severe in 42.2%. In 98.8% of the patients, the etiology of MS was rheumatic. LA thrombus was observed in 25% (64) of the patients and LA smoke was observed in 12.1% (31). Among other findings, mitral regurgitation (MR) was observed in 17.2% of the patients, aortic regurgitation (AR) in 5.1%, aortic stenosis (AS) in 4.7%, and tricuspid regurgitation (TR) in 48.8%. Five (2%) patients had atrial septal defect (ASD), 17.3% had left ventricular (LV) dysfunction, 15.2% had right ventricular (RV) dysfunction, and vegetation was seen in 11.8% of the patients. Patients with LA thrombus were found to be associated with the following conditions on a higher scale compared to those without: decreased ejection fraction (EF) (52 ±8.5% vs. 54.94 ±6.6%; p: 0.011); RV dysfunction (39.1% vs. 7.3%; p: <0.001); and presence of associated pathologies (82.8% vs. 43.8%; p: <0.001). Conclusion LA thrombus on TTE was detected in a significant number (25%) of patients with MS. It was also found to be strongly associated with the severity of the disease, reduced EF, RV dysfunction, and the presence of associated value pathologies.
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Affiliation(s)
- Khalil Ahmed
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Aziz Rehman Memon
- Critical Care Medicine, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Hussain Liaquat
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Mustajab Mujtaba
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Chander Parkash
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | | | - Musa Karim
- Statistics, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
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Piovani D, Danese S, Peyrin-Biroulet L, Bonovas S. Environmental, Nutritional, and Socioeconomic Determinants of IBD Incidence: A Global Ecological Study. J Crohns Colitis 2020; 14:323-331. [PMID: 31504350 DOI: 10.1093/ecco-jcc/jjz150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The wide variation in inflammatory bowel disease [IBD] incidence across countries entails an opportunity to recognise global disease determinants and hypothesise preventive policies. METHODS We fitted multivariable models to identify putative environmental, nutritional, and socioeconomic determinants associated with the incidence of IBD (i.e. ulcerative colitis [UC] and Crohn's disease [CD]). We used the latest available country-specific incidence rates, and aggregate data for 20 determinants, from over 50 countries accounting for more than half of the global population. We presented the associations with exponentiated beta coefficients (exp[β]) indicating the relative increase of disease incidence per unit increase in the predictor variables. RESULTS Country-specific incidence estimates demonstrate wide variability across the world, with a median of 4.8 new UC cases (interquartile range [IQR] 2.4-9.3), and 3.5 new CD cases [IQR 0.8-5.7] per 100 000 population per year. Latitude (exp[β] 1.05, 95% confidence interval [CI] 1.04‒1.06, per degree increase), prevalence of obesity [1.05, 1.02‒1.07, per 1% increase], and of tobacco smoking [0.97, 0.95‒0.99, per 1% increase] explained 71.5% of UC incidence variation across countries in the adjusted analysis. The model for CD included latitude [1.04, 1.02‒1.06], expenditure for health (1.03, 1.01‒1.05, per 100 purchasing power parity [PPP]/year per capita increase), and physical inactivity prevalence [1.03, 1.00‒1.06, per 1% increase], explaining 58.3% of incidence variation across countries. Besides expenditure for health, these associations were consistent in low/middle- and high-income countries. CONCLUSIONS Our analysis highlights factors able to explain a substantial portion of incidence variation across countries. Further high-quality research is warranted to develop global strategies for IBD prevention.
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Affiliation(s)
- Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IBD Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Silvio Danese
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IBD Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Hepato-Gastroenterology and INSERM U954, University Hospital of Nancy, Lorraine University, Vandoeuvre-lès-Nancy, France
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Milan, Italy.,IBD Center, Humanitas Clinical and Research Center - IRCCS, Milan, Italy
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Bitan A, Mazor-Dray E, Weinstein JM, Carmel S, Ilia R. Rheumatic Mitral Stenosis: Long-Term Follow-Up of Adult Patients with Nonsevere Initial Disease. Cardiology 2020; 145:155-160. [PMID: 32018250 DOI: 10.1159/000505481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 12/16/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is no consensus regarding the natural history of rheumatic mitral stenosis (MS) among adults presenting with nonsevere disease. This study aims to describe the progression of stenosis among adult rheumatic MS patients, to identify predictive factors for progression, and to assess the incidence of complications. METHODS A retrospective cohort analysis was performed among patients with rheumatic MS treated at a single center. Eighty-five patients were included with mild to moderate MS, ≥30 years old on initial echocardiography. Demographics, medical history, echocardiographic reports over at least 10 years, and related complications were obtained from a computerized database. RESULTS Over a period of 13.1 ± 2.38 years, 75 patients (88%) had no significant progression in stenosis severity. The final echocardiographic assessment demonstrated 2 groups with a significant difference between them regarding the mitral valve area (1.58 ± 0.44 vs. 1.1 ± 0.26 cm2, p = 0.001) and mean valvular pressure gradient (6.27 ± 2.52 vs. 8.5 ± 2.69 mm Hg, p = 0.01). Patients with indolent MS (group A) were compared to patients with progressive disease (group B), and a higher percent of Bedouin patients were found in group B (OR 8.036, p = 0.015). No significant differences were found in other parameters. Complications including atrial fibrillation, cerebral ischemic events, and impaired right ventricle function, although frequent, were not statistically different between the groups. CONCLUSIONS An indolent natural progression of rheumatic MS was observed in our study. Despite this finding, it still has potentially deleterious effects. Bedouin patients have a higher risk for progressive disease.
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Affiliation(s)
- Amram Bitan
- Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Efrat Mazor-Dray
- Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Jean Marc Weinstein
- Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Sarah Carmel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Reuben Ilia
- Department of Cardiology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel,
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76
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Machluf Y, Chaiter Y, Farkash R, Sebbag A, Fink DL. Rheumatic Fever in Large Cohort of Adolescents in Israel. Front Med (Lausanne) 2020; 6:328. [PMID: 32039216 PMCID: PMC6992586 DOI: 10.3389/fmed.2019.00328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Acute rheumatic fever (ARF) remains a major worldwide healthcare problem, despite its progressive decline in developed countries. The aims of our study were to estimate the prevalence of ARF among adolescents in Israel and to investigate risk factors. Methods: The study population consisted of 113,671 consecutive conscripts 16–19 years old, born during 1971–1993, who completed the medical profiling as part of the recruitment process to the IDF. ARF was diagnosed according to Jones criteria at time of illness, with confirmation relying on medical documentation and cardiologist evaluation including echocardiography. Results: The general prevalence rate of ARF was 0.12%. A downward trend was observed, from 0.19% among those born during 1971–1980 to 0.07% among those born during 1981–1993. Differences in prevalence of ARF were noted in sub-populations based on country of birth and origin—Israel, Ethiopia and the former soviet union (FUSSR). The prevalence rates of valvar disease among ARF+ and ARF– recruits were 15.7% and 0.95%, respectively. In multivariable logistic regression analyses, 4 variables were negatively associated with ARF: later birth year group, female gender, rural residence, youngest child; and 3 were positively associated with ARF: young parents, above normal BMI and valvar disease. Conclusion: Our study provides support for the documented decline in ARF prevalence and describes socio-demographic and anthropometric risk factors including the association with valvar disease and novel risk factors including above normal BMI and young parents, both warranting further investigation which might help in developing societal level prevention strategies.
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Affiliation(s)
- Yossy Machluf
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel.,Shamir Research Institute, University of Haifa, Haifa, Israel
| | - Yoram Chaiter
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel
| | | | - Anat Sebbag
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel
| | - Daniel Lyon Fink
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel.,Shaare Zedek Medical Center, Jerusalem, Israel.,HaEmek Medical Center, Afula, Israel
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Noubiap JJ, Agbor VN, Bigna JJ, Kaze AD, Nyaga UF, Mayosi BM. Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies. Sci Rep 2019; 9:17022. [PMID: 31745178 PMCID: PMC6863880 DOI: 10.1038/s41598-019-53540-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022] Open
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.
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Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Valirie N Agbor
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon. .,School of Public Health, Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France.
| | - Arnaud D Kaze
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Bongani M Mayosi
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,The Dean's Office, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Abstract
BACKGROUND The aim of this study is to investigate the prevalence of subclinical rheumatic heart disease in schoolchildren aged 5-18 by using portable echocardiography in Ankara, Turkey. METHODS The portable echocardiography screening was performed by a paediatric cardiologist for all of the cases. The mean age of 2550 healthy students was 11.09 ± 2.91 years (1339 females, 1211 males) in three private and three public schools. Echocardiographic studies were assessed according to 2012 World Heart Federation criteria for rheumatic heart disease. RESULTS After reviewing the echocardiographic images, 73 students were reevaluated by an advanced echocardiography device in the university hospital. Evidence of definite subclinical rheumatic heart disease was found in 39 students (15/1000) and borderline rheumatic heart disease in 20 students (8/1000). No children had any clinical symptoms. The mean age of children diagnosed with rheumatic heart disease and borderline rheumatic heart disease is 12.4 and 11.4 years, respectively. The risk of rheumatic heart disease was found to be increased sevenfold in girls between 14 and 18 years. We surprisingly observed that the prevalence of definite rheumatic heart disease in private schools located in high-income areas of Ankara was higher than that in public schools. CONCLUSIONS This is the first and largest single-centred echocardiographic screening study for subclinical rheumatic heart disease in Turkish schoolchildren. The frequency of rheumatic heart disease has been found to be 15/1000. This finding is similar to those of recent echocardiographic screening studies performed in middle and high-risk populations. We conclude that to decrease the burden of rheumatic heart disease, echocardiographic screening studies are necessary, and long-term follow-up of children with echocardiographically diagnosed subclinical rheumatic heart disease is needed.
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Pilgrim T, Windecker S. Expansion of transcatheter aortic valve implantation: new indications and socio-economic considerations. Eur Heart J 2019; 39:2643-2645. [PMID: 29701845 DOI: 10.1093/eurheartj/ehy228] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Thomas Pilgrim
- Department of Cardiology, University of Bern, Switzerland
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Muhamed B, Parks T, Sliwa K. Genetics of rheumatic fever and rheumatic heart disease. Nat Rev Cardiol 2019; 17:145-154. [PMID: 31519994 DOI: 10.1038/s41569-019-0258-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 12/13/2022]
Abstract
Rheumatic heart disease (RHD) is a complication of group A streptococcal infection that results from a complex interaction between the genetic make-up of the host, the infection itself and several other environmental factors, largely reflecting poverty. RHD is estimated to affect 33.4 million people and results in 10.5 million disability-adjusted life-years lost globally. The disease has long been considered heritable but still little is known about the host genetic factors that increase or reduce the risk of developing RHD. In the 1980s and 1990s, several reports linked the disease to the human leukocyte antigen (HLA) locus on chromosome 6, followed in the 2000s by reports implicating additional candidate regions elsewhere in the genome. Subsequently, the search for susceptibility loci has been reinvigorated by the use of genome-wide association studies (GWAS) through which millions of variants can be tested for association in thousands of individuals. Early findings implicate not only HLA, particularly the HLA-DQA1 to HLA-DQB1 region, but also the immunoglobulin heavy chain locus, including the IGHV4-61 gene segment, on chromosome 14. In this Review, we assess the emerging role of GWAS in assessing RHD, outlining both the advantages and disadvantages of this approach. We also highlight the potential use of large-scale, publicly available data and the value of international collaboration to facilitate comprehensive studies that produce findings that have implications for clinical practice.
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Affiliation(s)
- Babu Muhamed
- Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Tom Parks
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Karen Sliwa
- Hatter Institute for Cardiovascular Diseases Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa.
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Butt HI, Shahbaz A, Nawaz H, Butt K. Comparative Clinical Characteristics of Rheumatic Heart Disease Patients Undergoing Surgical Valve Replacement. Cureus 2019; 11:e4889. [PMID: 31423369 PMCID: PMC6689495 DOI: 10.7759/cureus.4889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background To assess the prevalence patterns of isolated/mixed rheumatic valvular lesions and associated risk factors among rheumatic heart disease (RHD) patients undergoing surgical valve replacement. Methods An analytical cross-sectional design was used. Purposive sampling was used to select 87 RHD patients who underwent a first-time valve replacement for mitral, aortic, or both valves between April 1 and October 20, 2016, at Punjab Institute of Cardiology, Lahore, Pakistan. Patients with systemic hypertension, diabetes mellitus type-II, congenital heart defects, coronary artery disease, non-rheumatic valvular degeneration, positive test for hepatitis C, or undergoing concomitant coronary artery bypass graft or a ‘redo’ valve replacement procedure were excluded. A proforma was used to collect preoperative data on patients’ demographics, laboratory investigations, electrocardiogram (ECG), and transthoracic echocardiography reports. Results Age (mean ± S.D.) was 32.79 ± 13.06 years, which was divided into four quartile-based groups. Forty-six (52.9%) cases were males. The majority (56.3%) of patients underwent mitral valve replacement. Mitral regurgitation (MR, 80%) was the most common lesion. Of 71 available ECGs, atrial fibrillation was observed in 46.5% cases. Increasing age group was negatively correlated with MR severity (τc = -0.188, p-value = 0.033) and positively with aortic stenosis (AS) severity (τc = 0.141, p-value = 0.010). No significant elevations were observed for anti-streptolysin O titer, C-reactive protein, and leukocyte count, though the erythrocyte sedimentation rate was abnormally high in 46.94% cases. Conclusions MR was the most common lesion. MR was more severe in younger patients whilst AS was more severe in older cases. There is little evidence of ongoing residual inflammation.
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Affiliation(s)
- Hamza I Butt
- Statistics, Government College University, Lahore, PAK
| | - Ahmad Shahbaz
- Cardiac Surgery, Punjab Institute of Cardiology, Lahore, PAK
| | - Haroon Nawaz
- Internal Medicine, Lahore Medical and Dental College, Lahore, PAK
| | - Khurram Butt
- Internal Medicine, Florida Hospital Orlando, Orlando, USA
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Beaton A, Okello E, Scheel A, DeWyer A, Ssembatya R, Baaka O, Namisanvu H, Njeri A, Matovu A, Namagembe I, Mccarter R, Carapetis J, Destigter K, Sable C. Impact of heart disease on maternal, fetal and neonatal outcomes in a low-resource setting. Heart 2019; 105:755-760. [PMID: 30415203 PMCID: PMC11181686 DOI: 10.1136/heartjnl-2018-313810] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/04/2018] [Accepted: 10/06/2018] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The burden of pre-existing cardiovascular disease and the contribution to adverse pregnancy outcomes are not robustly quantified, particularly in low-income countries. We aimed to determine both the prevalence of maternal heart disease through active case finding and its attributable risk to adverse pregnancy outcomes. METHODS We conducted a 24-month prospective longitudinal investigation in three Ugandan health centres, using echocardiography for active case finding during antenatal care. Women with and without heart disease were followed to 6 weeks post partum to determine pregnancy outcomes. Prevalence of heart disease was calculated. Per cent attributable risk estimates were generated for maternal, fetal and neonatal mortality. RESULTS Screening echocardiography was performed in 3506 women. The prevalence of heart disease was 17 per 1000 women (95% CI 13 to 21); 15 per 1000 was rheumatic heart disease. Only 3.4% of women (2/58) had prior diagnosis. Cardiovascular complications occurred in 51% of women with heart disease, most commonly heart failure. Per cent attributable risk of heart disease on maternal mortality was 88.6% in the exposed population and 10.8% in the overall population. Population attributable risk of heart disease on fetal death was 1.1% and 6.0% for neonatal mortality CONCLUSIONS: Occult maternal heart disease may be responsible for a substantial proportion of adverse pregnancy outcomes in low-resource settings. Rheumatic heart disease is, by far, the most common condition, urging global prioritisation of this neglected cardiovascular disease.
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Affiliation(s)
- Andrea Beaton
- Children’s National Medical Center, Cincinnati, Ohio, USA
| | | | - Amy Scheel
- Children’s National Medical Center, Cincinnati, Ohio, USA
| | - Alyssa DeWyer
- Children’s National Medical Center, Cincinnati, Ohio, USA
| | | | | | | | - Angela Njeri
- Imaging the World Africa, Kampala, Uganda
- Mubende Regional Referral Hospital, Mubende, Uganda
| | | | - Imelda Namagembe
- Mulago National Referral Hospital, Kampala, Uganda
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | | | | | | | - Craig Sable
- Children’s National Medical Center, Cincinnati, Ohio, USA
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Ekure EN, Amadi C, Sokunbi O, Kalu N, Olusegun-Joseph A, Kushimo O, Hassan O, Ikebudu D, Onyia S, Onwudiwe C, Nwankwo V, Akinwunmi R, Awusa F, Akere Z, Dele-Salawu O, Ajayi E, Ale O, Muoneke D, Muenke M, Kruszka P, Beaton A, Sable C, Adeyemo A. Echocardiographic screening of 4107 Nigerian school children for rheumatic heart disease. Trop Med Int Health 2019; 24:757-765. [PMID: 30938017 DOI: 10.1111/tmi.13235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Echocardiographic screening for Rheumatic Heart Disease (RHD) in Africa has revealed prevalence rates in the range of 0.5-7.4%. There are no recent large population-based studies in Nigeria. The objective of the study was to determine the prevalence of RHD in a large sample of Nigerian school children. METHODS Using portable transthoracic echocardiography and auscultation, school children aged 5 years to 16 years in Lagos, Nigeria were screened for RHD. Diagnosis was based on the 2012 World Heart Federation echocardiographic criteria. RESULTS The 4107 children screened had mean age of 11.3 years (SD = 2.6) and 2206 (53.7%) were females. There were 38 children with abnormal echocardiograms, of which 11 (0.27%) showed RHD including two cases of definite RHD giving a prevalence of 2.7/1000 [2.9/1000 in the peri-urban, 2.4/1000 in the urban area). Echocardiography detected RHD 10 times better than auscultation [echocardiography 11 (0.27%) vs. auscultation 1 (0.02%); P = 0.003]. The remaining 27 children with abnormal echocardiograms had congenital heart defects (CHD) giving a prevalence of 6.6/1000 for CHD, a yield higher than for RHD. CONCLUSION Prevalence of RHD among school children in Lagos, South West Nigeria is low compared to other African countries, possibly due to better access to medical care and antibiotic treatment for infections. Our data provides evidence that RHD prevalence may vary substantially within sub-Saharan Africa, necessitating targeted population-based sampling to better understand disease burden and distribution. Further work is needed to compare within- and between-country RHD prevalence as a basis for programme planning and control efforts.
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Affiliation(s)
- Ekanem N Ekure
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Casmir Amadi
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ogochukwu Sokunbi
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nnenna Kalu
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Akinsanya Olusegun-Joseph
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oyewole Kushimo
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olayinka Hassan
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Desmond Ikebudu
- Central Research Laboratory, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sophia Onyia
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chinonso Onwudiwe
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Victor Nwankwo
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Remi Akinwunmi
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Fukpode Awusa
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Zainab Akere
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olaolu Dele-Salawu
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Elizabeth Ajayi
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olagoke Ale
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Dorothy Muoneke
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Maximillian Muenke
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paul Kruszka
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Craig Sable
- Children's National Medical Center, Washington, DC, USA
| | - Adebowale Adeyemo
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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84
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Condemi F, Rossi G, Lupiz M, Pagano A, Zamatto F, Marini S, Romeo F, De Maio G. Screening of asymptomatic rheumatic heart disease among refugee/migrant children and youths in Italy. Pediatr Rheumatol Online J 2019; 17:12. [PMID: 30940181 PMCID: PMC6444853 DOI: 10.1186/s12969-019-0314-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/21/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a chronic condition responsible of congestive heart failure, stroke and arrhythmia. Almost eradicated in high-income countries (HIC), it persists in low- and middle-income countries. The purpose of the study was to assess the feasibility and meaningfulness of ultrasound-based RHD screening among the population of unaccompanied foreign minors in Italy and determine the burden of asymptomatic RHD among this discrete population. METHODS From February 2016 to January 2018, Médecins Sans Frontières conducted a weekly mobile screening by echocardiography in reception centers and family houses for unaccompanied foreign minors in Rome, followed by fix echocardiographic retesting for those resulting positive at screening. 'Definite' and 'borderline' cases were defined according to the World Hearth Federation criteria. RESULTS Six hundred fifty-three individuals (13-26 years old) were screened; 95.6% were below 18 years old (624/653). Six 'definite RHD' were identified at screening, yielding a detection rate of 9.2‰ (95% CI 4.1-20.3‰), while 285 (436.4‰) were defined as 'borderline' (95% CI 398.8-474.9‰). Out of 172 "non-negative borderline" cases available for being retested (113 "non-negative borderline" lost in follow-up), additional 11 were categorized as 'definite RHD', for a total of 17 'definite RHD', yielding a final prevalence of 26.0‰ (95% CI 16.2-41.5‰) (17/653), and 122 (122/653) were confirmed as 'borderline' (final prevalence of 186.8‰, 95% CI 158.7-218.7). In multivariate logistic regression analysis the presence of systolic murmur was a strong predictor for both 'borderline' (OR 4.3 [2.8-6.5]) and 'definite RHD' (OR 5.2 [1.7-15.2]), while no specific country/geographic area of origin was statistically associated with an increased risk of latent, asymptomatic RHD. CONCLUSIONS Screening for RHD among the unaccompanied migrant minors in Italy proved to be feasible. The burden of 'definite RHD' was similar to that identified in resource-poor settings, while the prevalence of 'borderline' cases was higher than reported in other studies. In view of these findings, the health system of high-income countries, hosting migrants and asylum seekers, are urged to adopt screening for RHD in particular among the silent and marginalized population of refugee and migrant children.
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Affiliation(s)
- Fortunata Condemi
- Médecins Sans Frontières-Operational Centre Brussels, Italy Mission, Rome, Italy ,0000 0001 2300 0941grid.6530.0Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy
| | - Gabriele Rossi
- Médecins Sans Frontières-Operational Centre Brussels, Medical Department, Brussels, Belgium.
| | - Miguel Lupiz
- Médecins Sans Frontières-Operational Centre Brussels, Italy Mission, Rome, Italy
| | - Antonio Pagano
- 0000 0000 9120 6856grid.416651.1National Institute for Health, Migration and Poverty, Rome, Italy
| | - Federica Zamatto
- Médecins Sans Frontières-Operational Centre Brussels, Operations Department, Rome, Italy
| | - Stefano Marini
- 0000 0001 2300 0941grid.6530.0Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Romeo
- 0000 0001 2300 0941grid.6530.0Department of Cardiovascular Disease, University of Rome Tor Vergata, Rome, Italy
| | - Gianfranco De Maio
- Médecins Sans Frontières-Operational Centre Brussels, Italy Mission, Rome, Italy
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85
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Leal MTBC, Passos LSA, Guarçoni FV, Aguiar JMDS, Silva RBRD, Paula TMND, Santos RFD, Nassif MCL, Gomes NFA, Tan TC, Nunes MCP. Rheumatic heart disease in the modern era: recent developments and current challenges. Rev Soc Bras Med Trop 2019; 52:e20180041. [PMID: 30892546 DOI: 10.1590/0037-8682-0041-2019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 02/05/2019] [Indexed: 01/04/2023] Open
Abstract
Rheumatic heart disease (RHD) remains a major cause of preventable death and disability in children and young adults. Despite significant advances in medical technology and increased understanding of disease mechanisms, RHD continues to be a serious public health problem throughout the world, especially in low- and middle-income countries. Echocardiographic screening has played a key role in improving the accuracy of diagnosing RHD and has highlighted the disease burden. Most affected patients present with severe valve disease and limited access to life-saving cardiac surgery or percutaneous valve intervention, contributing to increased mortality and other complications. Although understanding of disease pathogenesis has advanced in recent years, key questions remain to be addressed. Preventing or providing early treatment for streptococcal infections is the most important step in reducing the burden of this disease.
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Affiliation(s)
| | - Livia Silva Araújo Passos
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil.,The Center for Excellence in Vascular Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Felipe Vieira Guarçoni
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | | | | | | | | | | | - Nayana F A Gomes
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, University of Western Sydney, NSW, Australia
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86
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Affiliation(s)
- Mohammed R Essop
- Faculty of Health Sciences, Department of Health Sciences, Division of Cardiology, University of the Witwatersrand, Johannesburg, South Africa (M.R.E). Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa (B.M.M.).
| | - Bongani M Mayosi
- Faculty of Health Sciences, Department of Health Sciences, Division of Cardiology, University of the Witwatersrand, Johannesburg, South Africa (M.R.E). Department of Medicine, Groote Schuur Hospital, University of Cape Town, South Africa (B.M.M.)
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87
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Nunes MCP, Sable C, Nascimento BR, Lima EMD, da Silva JLP, Diamantino AC, Oliveira KK, Okello E, Aliku T, Lwabi P, Colosimo EA, Ribeiro ALP, Beaton AZ. Simplified Echocardiography Screening Criteria for Diagnosing and Predicting Progression of Latent Rheumatic Heart Disease. Circ Cardiovasc Imaging 2019; 12:e007928. [DOI: 10.1161/circimaging.118.007928] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maria Carmo P. Nunes
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Minas Gerais, Brazil (M.C.P.N., B.R.N., A.C.D., K.K.B.O., A.L.P.R.)
- Department of Internal Medicine, School of Medicine, Belo Horizonte, Minas Gerais, Brazil (M.C.P.N., B.R.N., A.L.P.R.)
| | - Craig Sable
- Children’s National Health System, Washington, DC (C.S.)
| | - Bruno R. Nascimento
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Minas Gerais, Brazil (M.C.P.N., B.R.N., A.C.D., K.K.B.O., A.L.P.R.)
- Department of Internal Medicine, School of Medicine, Belo Horizonte, Minas Gerais, Brazil (M.C.P.N., B.R.N., A.L.P.R.)
| | - Emilly Malveira de Lima
- Statistical Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (E.M.d.L., E.A.C.)
| | | | - Adriana C. Diamantino
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Minas Gerais, Brazil (M.C.P.N., B.R.N., A.C.D., K.K.B.O., A.L.P.R.)
| | - Kaciane K.B. Oliveira
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Minas Gerais, Brazil (M.C.P.N., B.R.N., A.C.D., K.K.B.O., A.L.P.R.)
| | - Emmy Okello
- Uganda Heart Institute, Kampala (E.O., T.A., P.L.)
| | - Twalib Aliku
- Uganda Heart Institute, Kampala (E.O., T.A., P.L.)
| | - Peter Lwabi
- Uganda Heart Institute, Kampala (E.O., T.A., P.L.)
| | - Enrico Antonio Colosimo
- Statistical Department, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil (E.M.d.L., E.A.C.)
| | - Antonio Luiz P. Ribeiro
- Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, Minas Gerais, Brazil (M.C.P.N., B.R.N., A.C.D., K.K.B.O., A.L.P.R.)
- Department of Internal Medicine, School of Medicine, Belo Horizonte, Minas Gerais, Brazil (M.C.P.N., B.R.N., A.L.P.R.)
| | - Andrea Z. Beaton
- The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (A.Z.B.)
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'CLAS' score: an objective tool to standardize and predict mitral valve repairability. Indian J Thorac Cardiovasc Surg 2019; 35:15-24. [PMID: 33060964 DOI: 10.1007/s12055-018-0721-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/13/2018] [Accepted: 07/17/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose Carpentier's classification has been used to classify both stenotic and regurgitant lesions. However, given the extreme variability of lesions, a universal nomenclature suggestive of the complexity and the prognosis of the repair procedure for the entire spectrum of the mitral valve disease still remains elusive. We present the predictors of mitral valve repairability with the help of a four-level-based 'CLAS' scoring system. Methods A total of 394 patients undergoing mitral valve procedure were prospectively studied. The valvular apparatus was divided into four sub-units, namely Commissures (C), Leaflet (L), Annulus (A), and Subvalvular apparatus (S), and the components were scored individually and the summation scores were calculated. Based on our results, three CLAS groups were formulated. Results A total of 376 (n = 394) patients underwent successful MVRep (95.43%; on-table failure in 18 patients). A total of 276 were rheumatic, 51 degenerative, 28 congenital, and 16 had infective endocarditis. Thirty-day mortality was 14 (3.72%) while delayed re-intervention rate was 8 (2.12%). The mean follow-up period was 30 months. One hundred percent patients with a CLAS score ≤ 8 had a successful repair as compared to 93.33 and 69.69%, respectively, for patients with scores between 9 and 12 and > 12, respectively. The cardio pulmonary bypass time, aortic-cross-clamp time, and ICU stay also showed a significant correlation with the patient's 'CLAS' groups. Conclusion The CLAS score is highly predictive of a successful repair. We thus propose that, in the patients with a score of ≤ 8, repair should always be attempted irrespective of the pathology. The patients expected to be scored > 8 should be referred to a repair reference center.
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Negi PC, Merwaha R, Rao S, Asotra S, Mahajan A, Joshi A. School-based surveillance for detection of children with acute pharyngitis, rheumatic fever/rheumatic heart disease in Shimla district, Himachal Pradesh, India-A cluster randomized controlled trial. Indian Heart J 2019; 70 Suppl 3:S74-S81. [PMID: 30595325 PMCID: PMC6309137 DOI: 10.1016/j.ihj.2018.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/22/2018] [Accepted: 05/26/2018] [Indexed: 11/24/2022] Open
Abstract
Background The lack of surveillance system is a major barrier in prevention and control of rheumatic fever/rheumatic heart disease (RF/RHD). Efficacy of school-based surveillance was evaluated for detection of acute pharyngitis and RF/RHD in Shimla district, HP. Methods The schools in district Shimla were randomly assigned to intervention and controlled arm (442 vs. 441 schools). The trained nodal teachers reported children with symptoms of acute pharyngitis and or RF/RHD in intervention arm and children taken to hospitals by parents for symptoms of acute pharyngitis and or RF/RHD under control arm through mobile phone to coordinating centre. Final outcome for presence of RF/RHD or other heart Diseases was recorded after examination at nearest primary health centers and/or at Indira Gandhi Medical College Hospital, Shimla. Difference in detection rate between intervention arm and control arm was compared using Z test. Results The number of school children reported from intervention group was significantly higher than in control due to suspected symptoms of acute pharyngitis and or RF/RHD were 65 (2.84/1000) and 15 (0.60/1000), respectively (p < 0.01). Only 4 children in each arm were found to have heart diseases, with prevalence of (0.17/1000 and 0.16/1000), respectively, after clinical and echocardiography evaluation. In intervention arm, one child had RHD while three had congenital heart disease; in control arm, one child had congenital heart disease and three had RHD. Conclusions School based surveillance had higher rate of suspecting children with acute pharyngitis and or RF/RHD although with low specificity. There is a need of future studies to demonstrate the effectiveness of the proposed intervention in endemic regions of the state.
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Affiliation(s)
| | | | | | | | | | - Ashish Joshi
- CUNY School of Public Health University, New York, USA
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90
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Barik R. Secondary prophylaxis to control rheumatic heart disease in developing countries: Put into a cage if can't be killed. Indian Heart J 2018; 70:907-910. [PMID: 30580864 PMCID: PMC6306397 DOI: 10.1016/j.ihj.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 12/25/2017] [Accepted: 01/08/2018] [Indexed: 01/17/2023] Open
Abstract
A significant socioeconomic inequality is the main barrier to achieve primordial prevention of rheumatic heart disease (RHD) in the developing countries. An effective vaccine with affordable cost against Streptococcus yet to be identified. The subclinical nature of rheumatic fever (RF) is the main hurdle for effective primary prevention of RHD. When RF and RHD are recognized at the earliest, treated adequately and SP with penicillin is strictly followed, then this disease can be kept under control though cannot be eradicated.
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91
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Ben Halima A, Ouali S, Mourali MS, Chabrak S, Chettaoui R, Ben Halima M, Haggui A, Larbi N, Krichène S, Marrakchi S, Kacem S, Chrigui R, Abbes MF, Baccar H, Baraket N, Ben Halima N, Ben Khalfallah A, Ben Mbarek M, Ben Youssef S, Boughzala E, Boujnah MR, Drissa H, Gamra H, Gasmi A, Haouala H, Harrath Y, Issa I, Jeridi G, Kachboura S, Kammoun S, Kraiem S, Maatouk F, Milouchi S, Nasraoui W, Neji A, Sayahi K, Sdiri W, Smati W, Tlili S, Abid L, Abdesselem S, Zakhama L, Mahdhaoui A, Kammoun H, Ben Omrane S, Addad F. Design and Rationale of the National Tunisian Registry of Atrial Fibrillation: Protocol for a Prospective, Multicenter Trial. JMIR Res Protoc 2018; 7:e181. [PMID: 30322836 PMCID: PMC6231898 DOI: 10.2196/resprot.8523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/17/2017] [Indexed: 12/18/2022] Open
Abstract
Background Atrial fibrillation (AF) is an important health problem in Tunisia. A significant change in the epidemiological pattern of heart disease has been seen in the last 3 decades; however, no large prospective multicenter trial reflecting national data has been published so far. Robust data on the contemporary epidemiological profile and management of AF patients in Tunisia are limited. Objective The aim of this study is to analyze, follow, and evaluate patients with AF in a large multicenter nationwide trial. Methods A total of 1800 consecutive patients with AF by electrocardiogram, reflecting all populations of all geographical regions of Tunisia, will be included in the study, with the objective of describing the epidemiological pattern of AF. Patients will be officially enrolled in the National Tunisian Registry of Atrial Fibrillation (NATURE-AF) only if an electrocardiogram diagnosis (12-lead, 24-hour Holter, or other electrocardiographic documentation) confirming AF is made. The qualifying episode of AF should have occurred within the last year, and patients do not need to be in AF at the time of enrollment. Patients will be followed for 1 year. Incidence of stroke or transient ischemic attack, thromboembolic events, and cardiovascular death will be recorded as the primary end point, and hemorrhagic accidents, measurement of international normalized ratio, and time in therapeutic range will be recorded as secondary end points. Results Results will be available at the end of the study; the demographic profile and general risk profile of Tunisian AF patients, frequency of anticoagulation, frequency of effective treatment, and risks of thromboembolism and bleeding will be evaluated according to the current guidelines. Major adverse events will be determined. NATURE-AF will be the largest registry for North African AF patients. Conclusions This study would add data and provide a valuable opportunity for real-world clinical epidemiology in North African AF patients with insights into the uptake of contemporary AF management in this developing region. Trial Registration ClinicalTrials.gov NCT03085576; https://clinicaltrials.gov/ct2/show/NCT03085576 (Archived by WebCite at http://www.webcitation.org/6zN2DN2QX) Registered Report Identifier RR1-10.2196/8523
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Affiliation(s)
- Afef Ben Halima
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Sana Ouali
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Mohamed Sami Mourali
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Sonia Chabrak
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Rafik Chettaoui
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Manel Ben Halima
- La Rabta Hospital, Tunis, Tunisia.,National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Abdeddayem Haggui
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Principal Military Hospital, Tunis, Tunisia
| | - Noureddine Larbi
- La Rabta Hospital, Tunis, Tunisia.,National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Salma Krichène
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Sonia Marrakchi
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Abderrahman Mami Hospital, Ariana, Tunisia
| | - Slim Kacem
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Rim Chrigui
- National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | | | | | | | | | | | | | | | | | | | | | - Habib Gamra
- Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Ali Gasmi
- Mohamed Ben Sassi Hospital, Gabes, Tunisia
| | | | | | | | | | | | | | | | | | | | | | - Ali Neji
- Ben Guerdane Hospital, Ben Guerdane, Tunisia
| | | | | | | | | | - Leila Abid
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Hédi Chaker Hospital, Sfax, Tunisia
| | - Salem Abdesselem
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Lilia Zakhama
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Hospital of the Internal Security Forces, La Marsa, Tunisia
| | - Abdallah Mahdhaoui
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Farhat Hached Hospital, Sousse, Tunisia
| | - Helmi Kammoun
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,National Tunisian Registry of Atrial Fibrillation Steering Committee, Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia
| | - Skander Ben Omrane
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,La Rabta Hospital, Tunis, Tunisia
| | - Faouzi Addad
- Tunisian Society of Cardiology and Cardiac Surgery, Tunis, Tunisia.,Abderrahman Mami Hospital, Ariana, Tunisia
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Scheel A, Ssinabulya I, Aliku T, Bradley-Hewitt T, Clauss A, Clauss S, Crawford L, DeWyer A, Donofrio MT, Jacobs M, Klein J, Moore TE, Okello E, Scheel J, Shaw R, Sable C, Lwabi P, Watkins DA, Beaton A. Community study to uncover the full spectrum of rheumatic heart disease in Uganda. Heart 2018; 105:60-66. [DOI: 10.1136/heartjnl-2018-313171] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 11/04/2022] Open
Abstract
ObjectiveEstimates of the prevalence of rheumatic heart disease (RHD) in many endemic countries are limited to samples of children attending schools, which generate an incomplete picture of disease burden in communities. The present study conducted household-based RHD screening in a representative community in Gulu district, Uganda.MethodsMembers of households identified through a two-stage cluster-sampling approach between the ages of 5 years and 50 years were invited to undergo limited cardiac testing with a handheld echocardiogram to assess for the presence of RHD. Suspicious cases underwent confirmatory echocardiogram with a fully functional machine.ResultsOf the 2453 community members screened, 2.45% (95% CI 1.87% to 3.14%) showed echocardiographic evidence of RHD with 1.26% (95% CI 0.860% to 1.79%) having definite RHD. The overall prevalence of RHD among participants <20 years was 2.52% (95% CI 1.78% to 3.45%), with a borderline prevalence of 1.97% (95% CI 1.33% to 2.82%) and a definite prevalence of 0.544% (95% CI 0.235% to 1.07%). Prevalence rates among youth increased with age and peaked in the age group of 16–20 years. The overall adult prevalence (>20 years) of RHD was 2.34% (95% CI 1.49% to 3.49%). The majority of definite cases were mild (81%) and marked by mitral regurgitation and associated morphological valve changes (71%).ConclusionOur data reveal a high prevalence of undiagnosed RHD within an endemic community and fill a critical gap in RHD epidemiology in African adults.
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Verma N, Vijayvergiya R, Grover S. Impact of balloon mitral valvotomy on quality of life and psychiatric morbidity in patients with severe mitral stenosis. Ind Psychiatry J 2018; 27:285-292. [PMID: 31359985 PMCID: PMC6592193 DOI: 10.4103/ipj.ipj_76_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To evaluate the quality of life (QoL), psychiatric comorbidities in patients with rheumatic heart disease-mitral stenosis (RHD-MS), and the impact of balloon mitral valvotomy (BMV) on the QoL and psychiatric morbidity. MATERIALS AND METHODS Fifty consecutive patients of RHD-MS were evaluated for QoL and psychiatric morbidity prior to BMV and at 3 months after the procedure. RESULTS The mean age of the study sample was 34.9 years (standard deviation, 11.1 years). At baseline assessment, majority (94%) had New York Heart Association Class II/III symptoms and QoL scores below average, that is, 50. About two-fifth (19 out of 50) of the patients had one or more psychiatric comorbidity, that is, depression (32%), anxiety (16%), and somatoform disorder (12%). Those with psychiatric comorbidity had poor QoL scores in social, emotional, and mental subscales (P < 0.05) at the baseline. At 3-month follow-up, there were significant improvement in symptoms and transmitral pressure gradients (P < 0.05), QoL scores (P < 0.05), and psychiatric comorbidities (P < 0.05) after BMV. Improvements in QoL were irrespective of the baseline psychiatric comorbidity. CONCLUSIONS High prevalence of psychiatric illness and poor QoL scores were observed in patients with RHD-MS. BMV significantly improves the QoL and psychiatric comorbidities.
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Affiliation(s)
- Nipun Verma
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajesh Vijayvergiya
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Coffey PM, Ralph AP, Krause VL. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review. PLoS Negl Trop Dis 2018; 12:e0006577. [PMID: 29897915 PMCID: PMC6016946 DOI: 10.1371/journal.pntd.0006577] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 06/25/2018] [Accepted: 06/03/2018] [Indexed: 02/08/2023] Open
Abstract
Background Rheumatic heart disease (RHD) poses a major disease burden among disadvantaged populations globally. It results from acute rheumatic fever (ARF), a complication of Group A Streptococcal (GAS) infection. These conditions are acknowledged as diseases of poverty, however the role of specific social and environmental factors in GAS infection and progression to ARF/RHD is not well understood. The aim of this systematic review was to determine the association between social determinants of health and GAS infection, ARF and RHD, and the effect of interventions targeting these. Methodology We conducted a systematic literature review using PubMed, the Cochrane Library and Embase. Observational and experimental studies that measured: crowding, dwelling characteristics, education, employment, income, nutrition, or socioeconomic status and the relationship with GAS infection, ARF or RHD were included. Findings for each factor were assessed against the Bradford Hill criteria for evidence of causation. Study quality was assessed using a standardised tool. Principle findings 1,164 publications were identified. 90 met inclusion criteria, comprising 91 individual studies. 49 (50.5%) were poor quality in relation to the specific study question. The proportion of studies reporting significant associations between socioeconomic determinants and risk of GAS infection was 57.1%, and with ARF/RHD was 50%. Crowding was the most assessed factor (14 studies with GAS infection, 36 studies with ARF/RHD) followed by socioeconomic status (6 and 36 respectively). The majority of studies assessing crowding, dwelling characteristics, education and employment status of parents or cases, and nutrition, reported a positive association with risk of GAS infection, ARF or RHD. Crowding and socioeconomic status satisfactorily met the criteria of a causal association. There was substantial heterogeneity across all key study aspects. Conclusion The extensive literature examining the role of social determinants in GAS infection, ARF and RHD risk lacks quality. Most were observational, not interventional. Crowding as a cause of GAS infection and ARF/RHD presents a practical target for prevention actions. Rates of rheumatic heart disease (RHD) are high in disadvantaged populations globally. It results from acute rheumatic fever (ARF), a complication of Group A Streptococcal (GAS) infection. These are described as diseases of poverty, but exactly what components of poverty promote them has been unclear. The aim of this review was to find what specific social and environmental factors are associated with GAS infection, ARF and RHD, and if actions targeting these can reduce disease rates. We did a search of published literature and found 90 relevant articles. Many supported an association between GAS infection, ARF or RHD and crowding, dwelling characteristics, low education level and employment status, poor nutrition and low social class. There was enough evidence to show that crowding and socioeconomic disadvantage increase the risk of GAS infection and ARF/RHD. However, most studies were of fair to poor quality in their ability to answer the research question, and there was little interventional research. This may relate to challenges inherent in intervening to change social determinants of health, but may also suggest lesser research attention to health issues affecting disadvantaged populations. The association between crowding and disease risk strongly supports initiatives to reduce crowding. This should become a key target for ARF and RHD prevention.
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Affiliation(s)
- Pasqualina M. Coffey
- Centre for Disease Control, Department of Health, Darwin, Northern Territory, Australia
- * E-mail:
| | - Anna P. Ralph
- Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Vicki L. Krause
- Centre for Disease Control, Department of Health, Darwin, Northern Territory, Australia
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95
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Munteanu V, Petaccia A, Contecaru N, Amodio E, Agostoni CV. Paediatric acute rheumatic fever in developed countries: Neglected or negligible disease? Results from an observational study in Lombardy (Italy). AIMS Public Health 2018; 5:135-143. [PMID: 30094276 PMCID: PMC6079050 DOI: 10.3934/publichealth.2018.2.135] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/21/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Acute Rheumatic Fever (ARF) is a multisystemic disease that results from an autoimmune reaction due to group A streptococcal infection. The disease affects predominantly children aged 5 to 15 years and although its incidence in developed Countries declined since the early 1900s, to date there is a paucity of data that confirm this epidemiological trend. Objective The study aimed to assess the burden of ARF in term of hospitalization and to describe the characteristics of acute rheumatic fever (ARF) in the paediatric population of Lombardy. Study design The study was carried out by analyzing hospital discharge records of patients resident of Lombardy and aged 0–17 years old who, from 2014 to 2016, were hospitalized with the diagnosis of ARF. The following variables have been studied: age, sex, municipality of residence, date of diagnosis of each patient, hospital of admission, and presentation of the disease. Results From 2014 to 2016, 215 patients were found to meet the inclusion criteria and diagnosed as affected from Acute Rheumatic Fever. The rate of hospitalization showed a slightly increasing trend from 3.42 in 2014 to about 5.0 in 2016. Moreover, ARF presented a typical seasonal trend with lower cases in the autumn and a peak of hospitalization in the spring. Conclusion To date, ARF seems to be a rare but not negligible disease in southern central European countries, and in Lombardy we estimated an annual hospitalization rate of 4.24 cases per 100,000 children. The increasing trend found in our study suggests that the burden of the disease could be reduced by involving multidisciplinary health professionals who, in addition to the paediatrician of free choice, would promote evidence based medicine management of the disease during all its clinical phases.
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Affiliation(s)
- Viorica Munteanu
- Department of Paediatrics, IRCCS Ospedale Maggiore Policlinico, DISCCO, University of Milan, Milan, Italy
| | - Antonella Petaccia
- Department of Paediatrics, IRCCS Ospedale Maggiore Policlinico, DISCCO, University of Milan, Milan, Italy
| | - Nicolae Contecaru
- Health Protection Agency of Brianza (Italy), Viale Elvezia n.2 Monza (MB) 20900
| | - Emanuele Amodio
- Health Protection Agency of Brianza (Italy), Viale Elvezia n.2 Monza (MB) 20900
| | - Carlo Virginio Agostoni
- Department of Paediatrics, IRCCS Ospedale Maggiore Policlinico, DISCCO, University of Milan, Milan, Italy
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96
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Davis K, Remenyi B, Draper ADK, Dos Santos J, Bayley N, Paratz E, Reeves B, Appelbe A, Cochrane A, Johnson TD, Korte LM, Do Rosario IM, Da Silva Almeida IT, Roberts KV, Carapetis JR, Francis JR. Rheumatic heart disease in Timor‐Leste school students: an echocardiography‐based prevalence study. Med J Aust 2018; 208:303-307. [DOI: 10.5694/mja17.00666] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/23/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Kimberly Davis
- Royal Darwin Hospital, Darwin, NT
- Hospital Nacional Guido Valadares, Dili, Timor‐Leste
| | | | - Anthony DK Draper
- Centre for Disease Control, Northern Territory Department of Health, Darwin, NT
| | | | | | | | | | - Alan Appelbe
- Geelong Cardiology Group, Barwon Health, Geelong, VIC
| | | | | | - Laura M Korte
- Paediatric WA Country Health Service – Kimberley, Broome, WA
| | | | | | | | | | - Joshua R Francis
- Royal Darwin Hospital, Darwin, NT
- Global and Tropical Health Division Menzies School of Health Research, Darwin, NT
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97
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Curry C, Zuhlke L, Mocumbi A, Kennedy N. Acquired heart disease in low-income and middle-income countries. Arch Dis Child 2018; 103:73-77. [PMID: 28838969 DOI: 10.1136/archdischild-2016-312521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/05/2017] [Accepted: 08/13/2017] [Indexed: 11/04/2022]
Abstract
The burden of illness associated with acquired cardiac disease in children in low-income and middle-income countries (LMIC) is significant and may be equivalent to that of congenital heart disease. Rheumatic heart disease, endomyocardial fibrosis, cardiomyopathy (including HIV cardiomyopathy) and tuberculosis are the most important causes. All are associated with poverty with the neediest children having the least access to care. The associated mortality and morbidity is high. There is an urgent need to improve cardiac care in LMIC, particularly in sub-Saharan Africa and parts of Southeast Asia where the burden is highest.
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Affiliation(s)
- Chris Curry
- Centre for Medical Education, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
| | - Liesl Zuhlke
- Cardiology, University of Cape Town, Cape Town, South Africa
| | - Ana Mocumbi
- Cardiology, University Eduardo Mondlane, Maputo, Mozambique
| | - Neil Kennedy
- Centre for Medical Education, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK
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98
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Abstract
Heart failure is a growing problem in sub-Saharan Africa. This arises as the prevalence of risk factors for cardiovascular disease rises, life expectancy increases and causes of heart failure more common in Africa, such as rheumatic heart disease and endomyocardial fibrosis, continue to be a significant issue. Lack of access to diagnostics is an issue with the expense and technical expertise required for echocardiography limiting access. Biomarker strategies may play a role here. Access to essential medicines is also limited and requires a renewed focus by the international community to ensure that appropriate medications are readily available, similar to that which has been implemented for HIV and malaria.
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Affiliation(s)
| | | | | | - Chris J Watson
- Centre for Experimental Medicine, Queens University Belfast, Northern Ireland
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99
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Abstract
Rheumatic heart disease (RHD) is a chronic valvular disease resulting after severe or repetitive episodes of acute rheumatic fever (ARF), an autoimmune response to group A Streptococcus infection. RHD has been almost eliminated with improved social and health infrastructure in affluent countries while it remains a neglected disease with major cause of morbidity and mortality in many low- and middle-income countries, and resource-limited regions of high-income countries. Despite our evolving understanding of the pathogenesis of RHD, there have not been any significant advances to prevent or halt progression of disease in recent history. Long-term penicillin-based treatment and surgery remain the backbone of a RHD control program in the absence of an effective vaccine. The advent of echocardiographic screening algorithms has improved the accuracy of diagnosing RHD and has shed light on the enormous burden of disease. Encouragingly, this has led to a rekindled commitment from researchers in the most affected countries to advocate and take bold actions to end this disease of social inequality.
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Affiliation(s)
- Bethel Woldu
- Vanderbilt Institute for Global Health, Vanderbilt University, 2525 West End Avenue, Suite 750, Nashville, TN, 37203, USA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke University, 2400 Pratt Street, Durham, NC, 27705, USA.
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100
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Abouzeid M, Katzenellenbogen J, Wyber R, Watkins D, Johnson TD, Carapetis J. Rheumatic heart disease across the Western Pacific: not just a Pacific Island problem. HEART ASIA 2017; 9:e010948. [PMID: 29403546 PMCID: PMC5791559 DOI: 10.1136/heartasia-2017-010948] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 11/17/2022]
Abstract
Some of the highest recorded rheumatic heart disease (RHD) prevalence and mortality rates are from the World Health Organization’s Western Pacific Region (WPR). RHD burden has been well documented in much of the WPR subregion of Oceania, but less is known about RHD outside the Pacific Islands and Australasia. We aimed to review RHD burden in WPR outside Oceania to identify countries with high RHD burden and those with contemporary data gaps. We searched the peer-reviewed literature for English-language primary studies published between 1980 and April 2017 that reported RHD prevalence or mortality in the 13 WPR countries/areas outside Oceania, and Taiwan. We also searched for official government reports and health indicator documents. Results were synthesised narratively and reported stratified by 2015 Human Development Index (HDI) level. 30 peer-reviewed publications fulfilling inclusion criteria were identified, representing nine countries/areas. RHD prevalence and mortality have fallen in association with economic development, particularly in very high HDI countries. In several countries that have undergone recent economic development, RHD persists particularly among older populations. In poorer WPR countries there is a persistent RHD burden, including in young populations. Some countries had no available data. Although RHD burden has declined in many high-resource settings across the WPR, in several poorer countries, the impact of RHD appears to continue. Elsewhere, insufficient contemporary data make it difficult to gauge the current status of RHD burden and control. Concerted efforts are needed to fill information gaps and implement action to address this avoidable disease.
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Affiliation(s)
- Marian Abouzeid
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - Judith Katzenellenbogen
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
- School of Population and Global Health, University of Western Australia, Subiaco, Australia
| | - Rosemary Wyber
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
| | - David Watkins
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Department of Medicine, University of Washington, Seattle, United States
| | | | - Jonathan Carapetis
- Telethon Kids Institute, University of Western Australia, Subiaco, Australia
- Princess Margaret Hospital for Children, Perth, Western Australia
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