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Narayanan K, Marijon E. Rheumatic Heart Disease-A Neglected Tragedy in Young Patients. JAMA Cardiol 2024; 9:597-598. [PMID: 38837749 DOI: 10.1001/jamacardio.2024.1852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Affiliation(s)
- Kumar Narayanan
- Department of Cardiology, Medicover Hospitals, Hyderabad, India
- Paris Cardiovascular Research Centre, Inserm U970, Université Paris Cité, Paris, France
| | - Eloi Marijon
- Paris Cardiovascular Research Centre, Inserm U970, Université Paris Cité, Paris, France
- Division of Cardiology, European Georges Pompidou Hospital, Paris, France
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Marijon E, Mocumbi A, Narayanan K, Jouven X, Celermajer DS. Persisting burden and challenges of rheumatic heart disease. Eur Heart J 2021; 42:3338-3348. [PMID: 34263296 DOI: 10.1093/eurheartj/ehab407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/02/2021] [Accepted: 06/13/2021] [Indexed: 11/13/2022] Open
Abstract
Rheumatic heart disease (RHD) is the result of episodes of acute rheumatic fever with valvular (and other cardiac) damage caused by an abnormal immune response to group A streptococcal infections, usually during childhood and adolescence. As a result of improved living conditions and the introduction of penicillin, RHD was almost eradicated in the developed world by the 1980s. However, being a disease of poverty, its burden remains disproportionately high in the developing world, despite being a fundamentally preventable disease. Rheumatic heart disease generates relatively little attention from the medical and science communities, in contrast to other common infectious problems (such as malaria, HIV, tuberculosis), despite the major cardiovascular morbidity/mortality burden imposed by RHD. This relative neglect and paucity of funding have probably contributed to limited fundamental medical advances in this field for over 50 years. Given the importance of prevention before the onset of major valvular damage, the main challenges for RHD prevention are improving social circumstances, early diagnosis, and effective delivery of antibiotic prophylaxis. Early identification through ultrasound of silent, subclinical rheumatic valve lesions could provide an opportunity for early intervention. Simple echocardiographic diagnostic criteria and appropriately trained personnel can be valuable aids in large-scale public health efforts. In addition, a better understanding of the immunogenic determinants of the disease may provide potential routes to vaccine development and other novel therapies.
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Affiliation(s)
- Eloi Marijon
- University of Paris, PARCC, INSERM, Global Health Unit, Paris F-75015, France.,Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Ana Mocumbi
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.,Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Kumar Narayanan
- University of Paris, PARCC, INSERM, Global Health Unit, Paris F-75015, France.,Medicover Hospitals, Hyderabad, India
| | - Xavier Jouven
- University of Paris, PARCC, INSERM, Global Health Unit, Paris F-75015, France.,Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - David S Celermajer
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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