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Zhang X, Zhang J, Cai Y, Li Y, Qin S, Li J, Zeng D, Huang T, Huang LL, Zhong Y, Wei L, Wu J. Speckle-Tracking Echocardiography Predicts Adverse Left Ventricular Remodeling After Valve Replacement in Rheumatic Mitral Stenosis. Ther Clin Risk Manag 2023; 19:755-766. [PMID: 37750070 PMCID: PMC10518172 DOI: 10.2147/tcrm.s419163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/14/2023] [Indexed: 09/27/2023] Open
Abstract
Background Rheumatic mitral stenosis(RMS) may leads to left ventricular remodeling (LVR), which can persist even after valve surgery. Identifying markers for early structure and function in patients with rheumatic heart disease who are at risk for adverse LVR after surgery can help determine the optimal timing of intervention. This study aimed to investigate whether preoperative parameters of global left ventricular long-axis strain (LVGLS) and mechanical discretization (MD) could predict postoperative adverse LVR. Methods A total of 109 adult patients with RMS and 50 healthy controls were enrolled in this study. Baseline clinical features, conventional echocardiography results, LVGLS, and MD were compared between the two groups. Pre- and post-surgery echocardiography measurements were collected, and adverse LVR was defined as a>15% increase in left ventricular end-diastolic volume or >10% decrease in left ventricular ejection fraction. Binary regression analysis was used to determine independent predictors of poor left ventricular remodeling. Results The variables associated with adverse LVR in this study were LVGLS (P<0.001, odds ratio: 1.996, 95% CI: 1.394-2.856) and MD (P=0.011, odds ratio: 1.031, 95% CI: 1.007-1.055). The poorly reconstructed group had lower absolute values of LVGLS and higher MD than the healthy control group and the non-poorly reconstructed group. A LVGLS cutoff of -15.0% was the best predictor for patients with poorly reconstructed LVR (sensitivity: 75.7%; specificity: 100.0%; AUC: 0.93), and a MD cutoff of 63.8ms was the best predictor (sensitivity: 63.8%; specificity: 98.6%; AUC: 0.88). Conclusion Speckle tracking echocardiography has potential value for predicting the progression of adverse LVR and for identifying non-responders among patients with RMS undergoing surgery.
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Affiliation(s)
- Xiaofeng Zhang
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Jiaqi Zhang
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yongzhi Cai
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yue Li
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Shiyun Qin
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Jingtao Li
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Decai Zeng
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Tongtong Huang
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Liu Liu Huang
- Department of Cardiothoracic Surgery, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Yanfen Zhong
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Lihui Wei
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
| | - Ji Wu
- Department of Ultrasonic Medicine, the First Affiliated Hospital of Guangxi Medical University, Nanning, People’s Republic of China
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Murugasen S, Abdullahi LH, Moloi H, Wyber R, Abrams J, Watkins DA, Engel ME, Zühlke LJ. Burden of disease and barriers to comprehensive care for rheumatic heart disease in South Africa: an updated systematic review protocol. BMJ Open 2023; 13:e073300. [PMID: 37263687 PMCID: PMC10254900 DOI: 10.1136/bmjopen-2023-073300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Rheumatic heart disease (RHD) is responsible for a significant burden of cardiovascular morbidity and mortality, and remains the most common cause of acquired heart disease among children and young adults in low-income and middle-income countries. Additionally, the global COVID-19 pandemic has forced the emergency restructuring of many health systems, which has had a broad impact on health in general, including cardiovascular disease. Despite significant cost to the health system and estimates from 2015 indicating both high incidence and prevalence of RHD in South Africa, no cohesive national strategy exists. An updated review of national burden of disease estimates, as well as literature on barriers to care for patients with RHD, will provide crucial information to assist in the development of a national RHD programme. METHODS AND ANALYSIS Using predefined search terms that capture relevant disease processes from Group A Streptococcal (GAS) infection through to the sequelae of RHD, a search of PubMed, Scopus, ISI Web of Science, Sabinet African Journals, SA Heart and Current and Completed Research databases will be performed. All eligible studies on RHD, acute rheumatic fever and GAS infection published from April 2014 to December 2022 will be included. Vital registration data for the same period from Statistics South Africa will also be collected. A standardised data extraction form will be used to capture results for both quantitative and qualitative analyses. All studies included in burden of disease estimates will undergo quality assessment using standardised tools. Updated estimates on mortality and morbidity as well as a synthesis of work on primary, secondary and tertiary prevention of RHD will be reported. ETHICS AND DISSEMINATION No ethics clearance is required for this study. Findings will be disseminated in a peer-reviewed journal and submitted to national stakeholders in RHD. PROSPERO REGISTRATION NUMBER CRD42023392782.
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Affiliation(s)
- Serini Murugasen
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town Faculty of Health Sciences, Rondebosch, South Africa
| | | | - Hlengiwe Moloi
- South African Medical Research Council, Tygerberg, South Africa
| | - Rosemary Wyber
- The George Institute for Global Health, Newtown, New South Wales, Australia
- Telethon Kids Institute, Nedlands, Western Australia, Australia
| | - Jessica Abrams
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town Faculty of Health Sciences, Rondebosch, South Africa
| | - David A Watkins
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Mark E Engel
- Department of Medicine, Cape Heart Institute, University of Cape Town Faculty of Health Sciences, Observatory, South Africa
| | - Liesl Joanna Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, University of Cape Town Faculty of Health Sciences, Rondebosch, South Africa
- South African Medical Research Council, Tygerberg, South Africa
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Chillo P, Mutagaywa R, Nkya D, Njelekela M, Kwesigabo G, Kahabuka F, Kerry V, Kamuhabwa A. Sub-clinical rheumatic heart disease (RHD) detected by hand-held echocardiogram in children participating in a school-based RHD prevention program in Tanzania. BMC Cardiovasc Disord 2023; 23:155. [PMID: 36966309 PMCID: PMC10040127 DOI: 10.1186/s12872-023-03186-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 03/15/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Rheumatic Heart Disease (RHD) continues to cause suffering and premature deaths in many sub-Saharan Africa (SSA) countries, where the disease is still endemic. RHD is largely preventable and determining its community burden is an important critical step in any RHD prevention program. METHODS We conducted a cross-sectional study of 5-16 years old pupils from 11 primary schools participating in an RHD prevention program in 4 districts in Tanzania, between 2018 and 2019. At the school, all children were invited to participate after receiving consent from their parents/guardians. Participating children filled a questionnaire and were auscultated for cardiac murmurs. Echocardiographic screening was done by two experienced cardiologists, using a hand-held machine (V-Scan, GE®). All positive screening tests were stored for further examination by the same two cardiologists to reach to a consensus of definite, borderline or no RHD, using a modified World Heart Federation (WHF) criterion. RESULTS Of the 6895 children invited, 4738 (68.7%) were screened and 4436 (64.3%) had complete data. The mean (SD) age was 10.04 (2.43) years, and 2422 (54.6%) were girls. Fifty three (1.2%) children were found to have a murmur. The proportion of children with trace or mild valvular regurgitation, sub-valvular/chordal thickening and valvular thickening/deformity were 8.3%, 1.3%, and 1.0%, respectively. Sub-clinical RHD was found in 95 children (59 definite and 36 borderline), giving a prevalence of 2.1%, [95% CI 1.7% - 2.6%]. Sub-clinical RHD was independently associated with female sex (aOR 1.83, 95% CI 1.18-2.85, p = 0.007), older age groups (aOR 1.73, 95% CI 1.10-2.72, p = 0.018 for age group 11-14 years; and aOR 3.02 95% CI 1.01-9.05, p = 0.048 for age group 15-16 years), as well as presence of a cardiac murmur, aOR 5.63 95% CI 2.31-13.69, p < 0.0001. None of the studied socio- or economic factors was associated with the presence of sub-clinical RHD in this study. CONCLUSION The prevalence of sub-clinical RHD among primary school children in Tanzania is 2.1%, similar to previous reports in SSA. Efforts to prevent and control RHD in our communities are highly warranted.
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Affiliation(s)
- Pilly Chillo
- Department of Internal Medicine, Section of Cardiology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Reuben Mutagaywa
- Department of Internal Medicine, Section of Cardiology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Deogratias Nkya
- Department of Paediatric and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Marina Njelekela
- Department of Physiology, Muhimbili University of Health and Allied Sciences and Deloitte Consulting Limited, Dar es Salaam, Tanzania
| | - Gideon Kwesigabo
- Department of Epidemiology and Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Febronia Kahabuka
- Department of Orthodontics Paedodontics & Community Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Vanessa Kerry
- Department of Global Health and Social Medicine, Seed Global Health Partnerships, Boston, USA
- Harvard Medical School, Center for Global Health, Mass General Hospital, Boston, MA, USA
| | - Appolinary Kamuhabwa
- Department of Clinical Pharmacy and Pharmacology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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Beaton A, Okello E, Rwebembera J, Grobler A, Engelman D, Alepere J, Canales L, Carapetis J, DeWyer A, Lwabi P, Mirabel M, Mocumbi AO, Murali M, Nakitto M, Ndagire E, Nunes MCP, Omara IO, Sarnacki R, Scheel A, Wilson N, Zimmerman M, Zühlke L, Karthikeyan G, Sable CA, Steer AC. Secondary Antibiotic Prophylaxis for Latent Rheumatic Heart Disease. N Engl J Med 2022; 386:230-240. [PMID: 34767321 DOI: 10.1056/nejmoa2102074] [Citation(s) in RCA: 79] [Impact Index Per Article: 39.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rheumatic heart disease affects more than 40.5 million people worldwide and results in 306,000 deaths annually. Echocardiographic screening detects rheumatic heart disease at an early, latent stage. Whether secondary antibiotic prophylaxis is effective in preventing progression of latent rheumatic heart disease is unknown. METHODS We conducted a randomized, controlled trial of secondary antibiotic prophylaxis in Ugandan children and adolescents 5 to 17 years of age with latent rheumatic heart disease. Participants were randomly assigned to receive either injections of penicillin G benzathine (also known as benzathine benzylpenicillin) every 4 weeks for 2 years or no prophylaxis. All the participants underwent echocardiography at baseline and at 2 years after randomization. Changes from baseline were adjudicated by a panel whose members were unaware of the trial-group assignments. The primary outcome was echocardiographic progression of latent rheumatic heart disease at 2 years. RESULTS Among 102,200 children and adolescents who had screening echocardiograms, 3327 were initially assessed as having latent rheumatic heart disease, and 926 of the 3327 subsequently received a definitive diagnosis on the basis of confirmatory echocardiography and were determined to be eligible for the trial. Consent or assent for participation was provided for 916 persons, and all underwent randomization; 818 participants were included in the modified intention-to-treat analysis, and 799 (97.7%) completed the trial. A total of 3 participants (0.8%) in the prophylaxis group had echocardiographic progression at 2 years, as compared with 33 (8.2%) in the control group (risk difference, -7.5 percentage points; 95% confidence interval, -10.2 to -4.7; P<0.001). Two participants in the prophylaxis group had serious adverse events that were attributable to receipt of prophylaxis, including one episode of a mild anaphylactic reaction (representing <0.1% of all administered doses of prophylaxis). CONCLUSIONS Among children and adolescents 5 to 17 years of age with latent rheumatic heart disease, secondary antibiotic prophylaxis reduced the risk of disease progression at 2 years. Further research is needed before the implementation of population-level screening can be recommended. (Funded by the Thrasher Research Fund and others; GOAL ClinicalTrials.gov number, NCT03346525.).
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Affiliation(s)
- Andrea Beaton
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Emmy Okello
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Joselyn Rwebembera
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Anneke Grobler
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Daniel Engelman
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Juliet Alepere
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Lesley Canales
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Jonathan Carapetis
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Alyssa DeWyer
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Peter Lwabi
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Mariana Mirabel
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Ana O Mocumbi
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Meghna Murali
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Miriam Nakitto
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Emma Ndagire
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Maria C P Nunes
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Isaac O Omara
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Rachel Sarnacki
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Amy Scheel
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Nigel Wilson
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Meghan Zimmerman
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Liesl Zühlke
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Ganesan Karthikeyan
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Craig A Sable
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
| | - Andrew C Steer
- From Cincinnati Children's Hospital Medical Center, and the Department of Pediatrics, University of Cincinnati School of Medicine - both in Cincinnati (A.B.); Uganda Heart Institute (E.O., J.R., J.A., P.L., M.N., E.N., I.O.O.), and the Department of Medicine, Makerere University (E.O.) - both in Kampala, Uganda; Children's National Hospital, Washington, DC (L.C., M. Murali, R.S., C.A.S.); Murdoch Children's Research Institute (A.G., D.E., A.C.S.), and Melbourne Children's Global Health, Royal Children's Hospital (D.E., A.C.S.), Melbourne, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth (J.C.) - all in Australia; Virginia Tech Carilion School of Medicine, Roanoke, VA (A.D.W.); Assistance Publique-Hôpitaux de Paris, Université de Paris, and Cardio-Oncologie, Hôpital Européen Georges-Pompidou - both in Paris (M. Mirabel); Instituto Nacional de Saúde, Maputo, Mozambique (A.O.M.); Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (M.C.P.N.); Emory University School of Medicine, Atlanta (A.S.); Green Lane Paediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand (N.W.); Geisel School of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH (M.Z.); the Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, and the Division of Cardiology, Department of Medicine, Groote Schuur Hospital - both in Cape Town, South Africa (L.Z.); and All India Institute of Medical Sciences, New Delhi, India (G.K.)
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Machipisa T, Chong M, Muhamed B, Chishala C, Shaboodien G, Pandie S, de Vries J, Laing N, Joachim A, Daniels R, Ntsekhe M, Hugo-Hamman CT, Gitura B, Ogendo S, Lwabi P, Okello E, Damasceno A, Novela C, Mocumbi AO, Madeira G, Musuku J, Mtaja A, ElSayed A, Elhassan HHM, Bode-Thomas F, Okeahialam BN, Zühlke LJ, Mulder N, Ramesar R, Lesosky M, Parks T, Cordell HJ, Keavney B, Engel ME, Paré G. Association of Novel Locus With Rheumatic Heart Disease in Black African Individuals: Findings From the RHDGen Study. JAMA Cardiol 2021; 6:1000-1011. [PMID: 34106200 PMCID: PMC8190704 DOI: 10.1001/jamacardio.2021.1627] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/25/2021] [Indexed: 01/02/2023]
Abstract
Importance Rheumatic heart disease (RHD), a sequela of rheumatic fever characterized by permanent heart valve damage, is the leading cause of cardiac surgery in Africa. However, its pathophysiologic characteristics and genetics are poorly understood. Understanding genetic susceptibility may aid in prevention, control, and interventions to eliminate RHD. Objective To identify common genetic loci associated with RHD susceptibility in Black African individuals. Design, Setting, and Participants This multicenter case-control genome-wide association study (GWAS), the Genetics of Rheumatic Heart Disease, examined more than 7 million genotyped and imputed single-nucleotide variations. The 4809 GWAS participants and 116 independent trio families were enrolled from 8 African countries between December 31, 2012, and March 31, 2018. All GWAS participants and trio probands were screened by use of echocardiography. Data analyses took place from May 15, 2017, until March 14, 2021. Main Outcomes and Measures Genetic associations with RHD. Results This study included 4809 African participants (2548 RHD cases and 2261 controls; 3301 women [69%]; mean [SD] age, 36.5 [16.3] years). The GWAS identified a single RHD risk locus, 11q24.1 (rs1219406 [odds ratio, 1.65; 95% CI, 1.48-1.82; P = 4.36 × 10-8]), which reached genome-wide significance in Black African individuals. Our meta-analysis of Black (n = 3179) and admixed (n = 1055) African individuals revealed several suggestive loci. The study also replicated a previously reported association in Pacific Islander individuals (rs11846409) at the immunoglobulin heavy chain locus, in the meta-analysis of Black and admixed African individuals (odds ratio, 1.16; 95% CI, 1.06-1.27; P = 1.19 × 10-3). The HLA (rs9272622) associations reported in Aboriginal Australian individuals could not be replicated. In support of the known polygenic architecture for RHD, overtransmission of a polygenic risk score from unaffected parents to affected probands was observed (polygenic transmission disequilibrium testing mean [SE], 0.27 [0.16] SDs; P = .04996), and the chip-based heritability was estimated to be high at 0.49 (SE = 0.12; P = 3.28 × 10-5) in Black African individuals. Conclusions and Relevance This study revealed a novel candidate susceptibility locus exclusive to Black African individuals and an important heritable component to RHD susceptibility in African individuals.
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Affiliation(s)
- Tafadzwa Machipisa
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Michael Chong
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Babu Muhamed
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Chishala Chishala
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gasnat Shaboodien
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shahiemah Pandie
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Jantina de Vries
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Nakita Laing
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alexia Joachim
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Rezeen Daniels
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Christopher T. Hugo-Hamman
- Rheumatic Heart Disease Clinic, Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Republic of Namibia
| | - Bernard Gitura
- Cardiology Department of Medicine, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Stephen Ogendo
- Cardiology Department of Medicine, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | | | | | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University/Nucleo de Investigaçao, Departamento de Medicina, Hospital Central de Maputo, Maputo, Mozambique
| | - Celia Novela
- Faculty of Medicine, Eduardo Mondlane University/Nucleo de Investigaçao, Departamento de Medicina, Hospital Central de Maputo, Maputo, Mozambique
| | - Ana O. Mocumbi
- Instituto Nacional de Saúde Ministério da Saúde, Maputo, Moçambique
| | - Goeffrey Madeira
- Emergency Department, World Health Organization Mozambique, Maputo, Mozambique
| | - John Musuku
- Department of Paediatrics and Child Health, University Teaching Hospital–Children’s Hospital, University of Zambia, Lusaka, Zambia
| | - Agnes Mtaja
- Department of Paediatrics and Child Health, University Teaching Hospital–Children’s Hospital, University of Zambia, Lusaka, Zambia
| | - Ahmed ElSayed
- Department of Cardiothoracic Surgery, Alshaab Teaching Hospital, Alazhari Health Research Center, Alzaiem Alazhari University, Khartoum, Sudan
| | - Huda H. M. Elhassan
- Department of Cardiothoracic Surgery, Alshaab Teaching Hospital, Alazhari Health Research Center, Alzaiem Alazhari University, Khartoum, Sudan
| | - Fidelia Bode-Thomas
- Department of Paediatrics, Jos University Teaching Hospital and University of Jos, Jos, Plateau State Nigeria
| | - Basil N. Okeahialam
- Department of Paediatrics, Jos University Teaching Hospital and University of Jos, Jos, Plateau State Nigeria
| | - Liesl J. Zühlke
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa
| | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Raj Ramesar
- Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Tom Parks
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Heather J. Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Newcastle upon Tyne, United Kingdom
| | - Bernard Keavney
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
- Manchester University National Health Service Foundation Trust, Manchester Academic Health Science CentreManchester, United Kingdom
| | - Mark E. Engel
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton Ontario, Canada
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6
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Khan A, Shafiq I, Jan M, Hassan Z. Echocardiographic assessment before and after Percutaneous Transvenous Mitral Commissurotomy in patients with Rheumatic Mitral Stenosis. Pak J Med Sci 2020; 37:104-108. [PMID: 33437259 PMCID: PMC7794164 DOI: 10.12669/pjms.37.1.2446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives To determine the changes produced in mitral valve morphology after Percutaneous Trans-Venous Mitral Commissurotomy. Methods Patients with mitral stenosis who underwent PTMC at the cardiology department of Lady Reading Hospital, Peshawar, Pakistan, from 2006-2016 were included in this study. All the data were manually obtained from the electronic medical record (M.F.E.). Wilkin's echocardiographic scoring system was used to assess the severity of mitral valve thickness, leaflet mobility, valvular calcification, and Subvalvular disease. The student t-test was used for mean comparison. P-value < 0.05 was considered significant. Results Of the total 229 patients, males were 96(41.9%), and females were 133(58.1%). The mean [SD] age of the patients was 25 ± 11years. The total Wilkin score was 7 ±1.5. 151(65.9%) were in New York Heart Association (NYHA) functional class III, and 78(34.1%) were in NYHA class IV. There was no immediate change after PTMC in systolic myocardial velocities (SV) measured at the lateral tricuspid annulus. The 2D mitral valve area increased from 0.98±0.94 cm2 to 1.78 ± 0.44 cm2 (P=0.001). Left Atrium diameter was 5.16±0.75 mm prior to PTMC, significantly decreased to 4.7± 0.7 mm (p=0.005) after PTMC. Ejection fraction (Left Ventricular Ejection Fraction) changed from 60.45± 8.25 mm Hg to 62.76±10 mm Hg (p=0.001). Mean Right Ventricular Ejection Fraction (RVEF) of patients before PTMC was 48.7 ± 4.7%, did not change significantly immediately after PTMC. Conclusion PTMC is associated with significant changes in mitral valve morphology in terms of splitting of the fused mitral commissures, increased MVA, improved leaflet excursion, and splitting of the subvalvular structures.
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Affiliation(s)
- Adnan Khan
- Adnan Khan Department of Paediatric, Rehman Medical Institute, Peshawar, Pakistan
| | - Ihtesham Shafiq
- Ihtesham Shafiq Department of Internal Medicine, Rehman Medical Institute, Peshawar, Pakistan
| | - Muneeb Jan
- Muneeb Jan Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
| | - Zair Hassan
- Zair Hassan Department of Cardiology, Lady Reading Hospital Peshawar, Peshawar, Pakistan
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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: 2] [Impact Index Per Article: 0.5] [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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8
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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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9
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Ali S, Subahi S. A multi-sectoral, non-governmental program for control of rheumatic heart disease: SUR I CAAN: A model for developing countries. Int J Cardiol 2020; 307:195-199. [DOI: 10.1016/j.ijcard.2020.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 10/21/2019] [Accepted: 03/02/2020] [Indexed: 11/24/2022]
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10
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Shawar YR, Shiffman J. Generating Global Priority for Addressing Rheumatic Heart Disease: A Qualitative Policy Analysis. J Am Heart Assoc 2020; 9:e014800. [PMID: 32308101 PMCID: PMC7428514 DOI: 10.1161/jaha.119.014800] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 03/18/2020] [Indexed: 01/24/2023]
Abstract
Background Rheumatic heart disease (RHD) poses a high burden in low-income countries, as well as among indigenous and other socioeconomically disadvantaged populations in high-income countries. Despite its severity and preventability, RHD receives insufficient global attention and resources. We conducted a qualitative policy analysis to investigate the reasons for recent growth but ongoing inadequacy in global priority for addressing RHD. Methods and Results Drawing on social science scholarship, we conducted a thematic analysis, triangulating among peer-reviewed literature, organizational documents, and 20 semistructured interviews with individuals involved in RHD research, clinical practice, and advocacy. The analysis indicates that RHD proponents face 3 linked challenges, all shaped by the nature of the issue. With respect to leadership and governance, the fact that RHD affects mostly poor populations in dispersed regions complicates efforts to coordinate activities among RHD proponents and to engage international organizations and donors. With respect to solution definition, the dearth of data on aspects of clinical management in low-income settings, difficulties preventing and addressing the disease, and the fact that RHD intersects with several disease specialties have fueled proponent disagreements about how best to address the disease. With respect to positioning, a perception that RHD is largely a problem for low-income countries and the ambiguity on its status as a noncommunicable disease have complicated efforts to convince policy makers to act. Conclusions To augment RHD global priority, proponents will need to establish more effective governance mechanisms to facilitate collective action, manage differences surrounding solutions, and identify positionings that resonate with policy makers and funders.
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Affiliation(s)
- Yusra Ribhi Shawar
- Department of International HealthBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMD
- Paul H. Nitze School of Advanced International StudiesJohns Hopkins UniversityWashingtonDC
| | - Jeremy Shiffman
- Department of International HealthBloomberg School of Public HealthJohns Hopkins UniversityBaltimoreMD
- Paul H. Nitze School of Advanced International StudiesJohns Hopkins UniversityWashingtonDC
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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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Effect of anaemia on the diagnosis of rheumatic heart disease using World Heart Federation criteria. Cardiol Young 2019; 29:862-868. [PMID: 31218969 DOI: 10.1017/s1047951119000404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is overlap between pathological mitral regurgitation seen in borderline rheumatic heart disease using World Heart Federation echocardiography criteria and physiologic regurgitation found in normal children. One possible contributing factor is higher rates of anaemia in endemic countries. OBJECTIVE To investigate the contribution of anaemia as a potential confounder in the diagnosis of rheumatic heart disease detected in echocardiographic screening. METHOD/DESIGN A novel Server 2012 data warehouse tool was used to incorporate haematology and echocardiography databases. The study included a convenience sample of patients from 5 to 18 years old without structural or functional heart disease that had a haemoglobin value within 1 month prior to an echocardiogram. Echocardiogram images were reviewed to determine presence or absence of World Heart Federation criteria for rheumatic heart disease. The rate of rheumatic heart disease among anaemic and non-anaemic children according to gender- and age-based norms groups was compared. RESULTS Of the 935 patients who met the study inclusion criteria, 406 were classified as anaemic. There was no difference in the rate of echocardiograms meeting criteria for borderline rheumatic heart disease in anaemic (2.0%, 95% CI 0.6-3.3%) and non-anaemic children (1.3%, 95% CI 0.3-2.3%). However, there was a statistically significant increase in rates of mitral regurgitation of unclear significance among anaemic versus non-anaemic patients (8.6 versus 3.6%; p = 0.0012). CONCLUSION Anaemia does not increase the likelihood of meeting echocardiographic criteria for borderline rheumatic heart disease. Future studies should evaluate for the correlation between anaemia and mitral regurgitation in endemic settings.
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Lee SS, Vedanthan R. Beyond Sharing and Shifting: Raising the Bar for Global Rheumatic Heart Disease Control. Glob Heart 2019; 14:265-267. [PMID: 31113732 DOI: 10.1016/j.gheart.2019.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 11/26/2022] Open
Affiliation(s)
- Scott S Lee
- Department of Medicine and Institute for Global Health, Vanderbilt University, Nashville, TN, USA.
| | - Rajesh Vedanthan
- Section for Global Health, Department of Population Health, New York University School of Medicine, New York, NY, USA
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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] [MESH Headings] [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
- Department 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
- National Institute for Health, Migration and Poverty, Rome, Italy
| | - Federica Zamatto
- Médecins Sans Frontières-Operational Centre Brussels, Operations Department, Rome, Italy
| | - Stefano Marini
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Romeo
- Department 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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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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16
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Affiliation(s)
- Chris T Longenecker
- University Hospitals Harrington Heart & Vascular Institute and Case Western Reserve University School of Medicine, Cleveland, OH
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17
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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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18
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Rusingiza EK, El-Khatib Z, Hedt-Gauthier B, Ngoga G, Dusabeyezu S, Tapela N, Mutumbira C, Mutabazi F, Harelimana E, Mucumbitsi J, Kwan GF, Bukhman G. Outcomes for patients with rheumatic heart disease after cardiac surgery followed at rural district hospitals in Rwanda. Heart 2018; 104:1707-1713. [PMID: 29678896 PMCID: PMC6173815 DOI: 10.1136/heartjnl-2017-312644] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, continued clinical follow-up, after cardiac surgery, is only available at urban referral centres. We implemented a decentralised, integrated care model to provide longitudinal care for patients with advanced rheumatic heart disease (RHD) at district hospitals in rural Rwanda before and after heart surgery. METHODS We collected data from charts at non-communicable disease (NCD) clinics at three rural district hospitals in Rwanda to describe the outcomes of 54 patients with RHD who received cardiac valve surgery during 2007-2015. RESULTS The majority of patients were adults (46/54; 85%), and 74% were females. The median age at the time of surgery was 22 years in adults and 11 years in children. Advanced symptoms-New York Heart Association class III or IV-were present in 83% before surgery and only 4% afterwards. The mitral valve was the most common valve requiring surgery. Valvular surgery consisted mostly of a single valve (56%) and double valve (41%). Patients were followed for a median of 3 years (range 0.2-7.9) during which 7.4% of them died; all deaths were patients who had undergone bioprosthetic valve replacement. For patients with mechanical valves, anticoagulation was checked at 96% of visits. There were no known bleeding or thrombotic events requiring hospitalisation. CONCLUSION Outcomes of postoperative patients with RHD tracked in rural Rwanda health facilities were generally good. With appropriate training and supervision, it is feasible to safely decentralise follow-up of patients with RHD to nurse-led specialised NCD clinics after cardiac surgery.
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Affiliation(s)
- Emmanuel K Rusingiza
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Ministry of Health, Kigali, Rwanda
| | - Ziad El-Khatib
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Canada
| | - Bethany Hedt-Gauthier
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Gedeon Ngoga
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | - Symaque Dusabeyezu
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
- World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Québec, Canada
| | - Neo Tapela
- Partners in Health/Inshuti Mu Buzima, Kigali, Rwanda
| | | | | | | | | | - Gene F Kwan
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Section of Cardiovascular Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts, USA
| | - Gene Bukhman
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Partners in Health, Boston, Massachusetts, USA
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19
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Musuku J, Engel ME, Musonda P, Lungu JC, Machila E, Schwaninger S, Mtaja A, Mulendele E, Kavindele D, Spector J, Tadmor B, Gutierrez MM, Van Dam J, Colin L, Long A, Fishman MC, Mayosi BM, Zühlke LJ. Prevalence of rheumatic heart disease in Zambian school children. BMC Cardiovasc Disord 2018; 18:135. [PMID: 29969998 PMCID: PMC6029054 DOI: 10.1186/s12872-018-0871-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 06/24/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The large global burden of rheumatic heart disease (RHD) has come to light in recent years following robust epidemiologic studies. As an operational research component of a broad program aimed at primary and secondary prevention of RHD, we sought to determine the current prevalence of RHD in the country's capital, Lusaka, using a modern imaging-based screening methodology. In addition, we wished to evaluate the practicality of training local radiographers in echocardiography screening methods. METHODS Echocardiography was conducted on a random sample of students in 15 schools utilizing a previously validated, abbreviated screening protocol. Through a task-shifting scheme, and in the spirit of capacity-building to enhance local diagnostic and research skills, general radiographers based at Lusaka University Teaching Hospital (UTH) were newly trained to use portable echocardiography devices. Students deemed as screen-positive were referred for comprehensive echocardiography and clinical examination at UTH. Cardiac abnormalities were classified according to standard World Heart Federation criteria. RESULTS Of 1102 students that were consented and screened, 53 students were referred for confirmatory echocardiography. Three students had definite RHD, 10 had borderline RHD, 29 were normal, and 11 students were lost to follow-up. The rates of definite, borderline, and total RHD were 2.7 per 1000, 9.1 per 1000, and 11.8 per 1000, respectively. Anterior mitral valve leaflet thickening and chordal thickening were the most common morphological defects. The pairwise kappa test showed fair agreement between the local radiographers and an echocardiographer quality assurance specialist. CONCLUSION The prevalence of asymptomatic RHD in urban communities in Zambia is within the range of results reported in other sub-Saharan African countries using the WHF criteria. Task-shifting local radiographers to conduct echocardiography was feasible. The results of this study will be used to inform ongoing efforts in Zambia to control and eventually eliminate RHD. TRIAL REGISTRATION The study was registered on clinicaltrials.gov ( #NCT02661763 ).
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Affiliation(s)
- John Musuku
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Mark E Engel
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Patrick Musonda
- School of Public Health University of Zambia, Lusaka, Zambia
| | - Joyce Chipili Lungu
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Elizabeth Machila
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Sherri Schwaninger
- Global Health, Novartis Institutes for BioMedical Research, Cambridge, MA, USA.
| | - Agnes Mtaja
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Evans Mulendele
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Dorothy Kavindele
- Department of Paediatrics & Child Health, University Teaching Hospital, Lusaka, Zambia
| | - Jonathan Spector
- Global Health, Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Brigitta Tadmor
- Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Marcelo M Gutierrez
- Global Health, Novartis Institutes for BioMedical Research, Basel, Switzerland
| | - Joris Van Dam
- Global Drug Development, Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Laurence Colin
- Global Drug Development, Novartis Institutes for BioMedical Research, Cambridge, MA, USA
| | - Aidan Long
- Department of Allergy and Clinical Immunology, Massachusetts General Hospital, Boston, MA, USA
| | - Mark C Fishman
- Harvard Department of Stem Cell and Regenerative Biology, Harvard University, Cambridge, MA, USA
| | - Bongani M Mayosi
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Liesl J Zühlke
- Department of Paediatrics, Red Cross War Memorials Children's Hospital, Cape Town, South Africa
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20
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Gomaa MH, Ali SS, Fattouh AM, Hamza HS, Badr MM. MBL2 gene polymorphism rs1800450 and rheumatic fever with and without rheumatic heart disease: an Egyptian pilot study. Pediatr Rheumatol Online J 2018; 16:24. [PMID: 29653582 PMCID: PMC5899397 DOI: 10.1186/s12969-018-0245-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatic fever (RF) is the result of an autoimmune response to pharyngitis caused by infection with Streptococcus pyogenes. RF is most prevalent in Africa and the Middle East. Rheumatic heart disease (RHD) is the most serious complication of RF. Mannose-binding lectin 2 gene (MBL2) has been reported to be correlated with different cardiac conditions. In Egyptian patients as a new studied ethnic population, it is the first time to evaluate the association between MBL2 gene polymorphism rs1800450 and RF with and without RHD. METHODS One hundred and sixty RF patients (80 with RHD and 80 without RHD) and eighty healthy ethnically matched controls were studied. MBL2 (rs1800450) was genotyped by real-time PCR using TaqMan® allele discrimination assay. The MBL level was measured by ELISA. Westergren erythrocytes sedimentation rate (ESR), anti-streptolysin O titer (ASOT), C-reactive protein (CRP) and complements (C3 and C4) were determined. RESULTS The AA genotype with high production of MBL was associated with increased risk of RHD more than the B allele carrying subjects. However, MBL2 genotype related to the low production of MBL was more frequently observed in those patients without RHD. CONCLUSIONS Our results suggested the involvement of MBL2 (rs1800450) polymorphism and its protein in RHD pathogenesis. Also, it might be a promising future strategy to utilize this polymorphism to help differentiate patients with RHD from those without RHD.
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Affiliation(s)
- Maher Hassan Gomaa
- Biochemistry Department-Faculty of Pharmacy (Boys), Al-Azhar University, Almokhayam Aldaem Street, 6th Province - 13465 Nasr City, Cairo, Egypt
| | - Shawkey Sadik Ali
- Biochemistry Department-Faculty of Pharmacy (Boys), Al-Azhar University, Almokhayam Aldaem Street, 6th Province - 13465 Nasr City, Cairo, Egypt
| | - Aya Mohamed Fattouh
- Department of Pediatrics, Kasr Al-Aini School of Medicine, Cairo University, P.O. Box 99, Manial El-Roda, Cairo, 11553 Egypt
| | - Hala Salah Hamza
- Department of Pediatrics, Kasr Al-Aini School of Medicine, Cairo University, P.O. Box 99, Manial El-Roda, Cairo, 11553 Egypt
| | - Mohamed Mohamed Badr
- Biochemistry Department-Faculty of Pharmacy (Boys), Al-Azhar University, Almokhayam Aldaem Street, 6th Province - 13465 Nasr City, Cairo, Egypt
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21
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Kotit S, Said K, ElFaramawy A, Mahmoud H, Phillips DIW, Yacoub MH. Prevalence and prognostic value of echocardiographic screening for rheumatic heart disease. Open Heart 2017; 4:e000702. [PMID: 29344370 PMCID: PMC5761310 DOI: 10.1136/openhrt-2017-000702] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 08/24/2017] [Accepted: 11/07/2017] [Indexed: 12/20/2022] Open
Abstract
Objective Rheumatic heart disease (RHD) remains a major health problem in many low-income and middle-income countries. The use of echocardiographic imaging suggests that subclinical disease is far more widespread than previously appreciated, but little is known as to how these mild forms of RHD progress. We have determined the prevalence of subclinical RHD in a large group of schoolchildren in Aswan, Egypt and have evaluated its subsequent progression. Methods Echocardiographic screening was performed on 3062 randomly selected schoolchildren, aged 5–15 years, in Aswan, Egypt. Follow-up of children with a definite or borderline diagnosis of RHD was carried out 48–60 months later to determine how the valvular abnormalities altered and to evaluate the factors influencing progression. Results Sixty children were initially diagnosed with definite RHD (19.6 per 1000 children) and 35 with borderline disease (11.4 per 1000); most had mitral valve disease. Of the 72 children followed up progression was documented in 14 children (19.4%) and regression in 30 (41.7%) children. Boys had lower rates of progression while older children had lower rates of regression. Functional defects of the valve even in the presence of structural features were associated with lower rates of progression and higher rates of regression than structural changes. Conclusions RHD has a high prevalence in Egypt. Although a high proportion of the abnormalities originally detected persisted at follow-up, both progression and regression of valve lesions were demonstrated.
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Affiliation(s)
- Susy Kotit
- National Heart and Lung Institute, Imperial College, London, UK.,Aswan Heart Centre, Aswan, Egypt.,Harefield Heart Science Centre, Imperial College London, London, UK
| | - Karim Said
- Aswan Heart Centre, Aswan, Egypt.,Cardiology Department, Kasr El Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr ElFaramawy
- Aswan Heart Centre, Aswan, Egypt.,Cardiology Department, Kasr El Ainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | | | - David I W Phillips
- Developmental Origins of Health and Disease Division, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Magdi H Yacoub
- National Heart and Lung Institute, Imperial College, London, UK.,Aswan Heart Centre, Aswan, Egypt.,Harefield Heart Science Centre, Imperial College London, London, UK
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22
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Katzenellenbogen JM, Ralph AP, Wyber R, Carapetis JR. Rheumatic heart disease: infectious disease origin, chronic care approach. BMC Health Serv Res 2017; 17:793. [PMID: 29187184 PMCID: PMC5708129 DOI: 10.1186/s12913-017-2747-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/20/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is a chronic cardiac condition with an infectious aetiology, causing high disease burden in low-income settings. Affected individuals are young and associated morbidity is high. However, RHD is relatively neglected due to the populations involved and its lower incidence relative to other heart diseases. METHODS AND RESULTS In this narrative review, we describe how RHD care can be informed by and integrated with models of care developed for priority non-communicable diseases (coronary heart disease), and high-burden communicable diseases (tuberculosis). Examining the four-level prevention model (primordial through tertiary prevention) suggests primordial and primary prevention of RHD can leverage off existing tuberculosis control efforts, given shared risk factors. Successes in coronary heart disease control provide inspiration for similarly bold initiatives for RHD. Further, we illustrate how the Chronic Care Model (CCM), developed for use in non-communicable diseases, offers a relevant framework to approach RHD care. Systems strengthening through greater integration of services can improve RHD programs. CONCLUSION Strengthening of systems through integration/linkages with other well-performing and resourced services in conjunction with policies to adopt the CCM framework for the secondary and tertiary prevention of RHD in settings with limited resources, has the potential to significantly reduce the burden of RHD globally. More research is required to provide evidence-based recommendations for policy and service design.
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Affiliation(s)
- Judith M Katzenellenbogen
- Telethon Kids Institute, The University of Western Australia, Perth, Western, Australia.
- School of Population and Global Health, The University of Western Australia, Perth, Western, Australia.
| | - Anna P Ralph
- Global and Tropical Health, Menzies School of Health Research, Darwin, Northern Territory, Australia
- Division of Medicine, Royal Darwin Hospital, Darwin, NT, Australia
| | - Rosemary Wyber
- Telethon Kids Institute, The University of Western Australia, Perth, Western, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, The University of Western Australia, Perth, Western, Australia
- Princess Margaret Hospital for Children, Perth, Western, Australia
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23
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Hunter LD, Monaghan M, Lloyd G, Pecoraro AJK, Doubell AF, Herbst PG. Screening for rheumatic heart disease: is a paradigm shift required? Echo Res Pract 2017; 4:R43-R52. [PMID: 28864463 PMCID: PMC5633059 DOI: 10.1530/erp-17-0037] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 12/02/2022] Open
Abstract
This focused review presents a critical appraisal of the World Heart Federation criteria for the echocardiographic diagnosis of rheumatic heart disease (RHD) and its performance in African RHD screening programmes. It identifies various logistical and methodological problems that negatively influence the current guideline’s performance. The authors explore novel RHD screening methodology that could address some of these shortcomings and if proven to be of merit, would require a paradigm shift in the approach to the echocardiographic diagnosis of subclinical RHD.
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Affiliation(s)
- L D Hunter
- Division of Cardiology, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
| | - M Monaghan
- King's College Hospital NHS Trust, London, UK
| | - G Lloyd
- Department of Echocardiography, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - A J K Pecoraro
- Division of Cardiology, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
| | - A F Doubell
- Division of Cardiology, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
| | - P G Herbst
- Division of Cardiology, Tygerberg Hospital and University of Stellenbosch, Cape Town, South Africa
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24
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Watkins DA, Johnson CO, Colquhoun SM, Karthikeyan G, Beaton A, Bukhman G, Forouzanfar MH, Longenecker CT, Mayosi BM, Mensah GA, Nascimento BR, Ribeiro ALP, Sable CA, Steer AC, Naghavi M, Mokdad AH, Murray CJL, Vos T, Carapetis JR, Roth GA. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015. N Engl J Med 2017; 377:713-722. [PMID: 28834488 DOI: 10.1056/nejmoa1603693] [Citation(s) in RCA: 686] [Impact Index Per Article: 98.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Rheumatic heart disease remains an important preventable cause of cardiovascular death and disability, particularly in low-income and middle-income countries. We estimated global, regional, and national trends in the prevalence of and mortality due to rheumatic heart disease as part of the 2015 Global Burden of Disease study. METHODS We systematically reviewed data on fatal and nonfatal rheumatic heart disease for the period from 1990 through 2015. Two Global Burden of Disease analytic tools, the Cause of Death Ensemble model and DisMod-MR 2.1, were used to produce estimates of mortality and prevalence, including estimates of uncertainty. RESULTS We estimated that there were 319,400 (95% uncertainty interval, 297,300 to 337,300) deaths due to rheumatic heart disease in 2015. Global age-standardized mortality due to rheumatic heart disease decreased by 47.8% (95% uncertainty interval, 44.7 to 50.9) from 1990 to 2015, but large differences were observed across regions. In 2015, the highest age-standardized mortality due to and prevalence of rheumatic heart disease were observed in Oceania, South Asia, and central sub-Saharan Africa. We estimated that in 2015 there were 33.4 million (95% uncertainty interval, 29.7 million to 43.1 million) cases of rheumatic heart disease and 10.5 million (95% uncertainty interval, 9.6 million to 11.5 million) disability-adjusted life-years due to rheumatic heart disease globally. CONCLUSIONS We estimated the global disease prevalence of and mortality due to rheumatic heart disease over a 25-year period. The health-related burden of rheumatic heart disease has declined worldwide, but high rates of disease persist in some of the poorest regions in the world. (Funded by the Bill and Melinda Gates Foundation and the Medtronic Foundation.).
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Affiliation(s)
- David A Watkins
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Catherine O Johnson
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Samantha M Colquhoun
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Ganesan Karthikeyan
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Andrea Beaton
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Gene Bukhman
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Mohammed H Forouzanfar
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Christopher T Longenecker
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Bongani M Mayosi
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - George A Mensah
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Bruno R Nascimento
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Antonio L P Ribeiro
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Craig A Sable
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Andrew C Steer
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Mohsen Naghavi
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Ali H Mokdad
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Christopher J L Murray
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Theo Vos
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Jonathan R Carapetis
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
| | - Gregory A Roth
- From the Division of General Internal Medicine, Department of Medicine (D.A.W.), the Institute for Health Metrics and Evaluation, Department of Global Health (C.O.J., M.H.F., M.N., A.H.M., C.J.L.M., T.V., G.A.R.), and the Division of Cardiology, Department of Medicine (G.A.R.), University of Washington, Seattle; the Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa (D.A.W., B.M.M.); the Murdoch Children's Research Institute and the Centre for International Child Heath, University of Melbourne, Melbourne, VIC (S.M.C., A.C.S.), and Telethon Kids Institute, University of Western Australia and Princess Margaret Hospital for Children, Perth, WA (J.R.C.) - both in Australia; the Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Children's National Health System, Washington, DC (A.B., C.A.S.); Program in Global NCDs and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, and the Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital - both in Boston (G.B.); the Division of Cardiology, Department of Medicine, Case Western Reserve University and University Hospitals Cleveland Medical Center, Cleveland (C.T.L.); the Center for Translation Research and Implementation Science and Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (G.A.M.); and the School of Medicine and Telehealth Center, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (B.R.N., A.L.P.R.)
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Cardiac strain findings in children with latent rheumatic heart disease detected by echocardiographic screening. Cardiol Young 2017; 27:1180-1185. [PMID: 28088920 DOI: 10.1017/s1047951116002778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Identification of patients with latent rheumatic heart disease by echocardiography presents a unique opportunity to prevent disease progression. Myocardial strain is a more sensitive indicator of cardiac performance than traditional measures of systolic function. OBJECTIVE The objective of this study was to test the hypothesis that abnormalities in myocardial strain may be present in children with latent rheumatic heart disease. METHODS Standard echocardiography images with electrocardiogram gating were obtained from Ugandan children found to have latent rheumatic heart disease as well as control subjects. Traditional echocardiography measures of systolic function were obtained, and offline global longitudinal strain analysis was performed. Comparison between groups was performed using strain as a continuous (Mann-Whitney U-test) and categorical (cut-off 5th percentile for age) variable. RESULTS Our study included 14 subjects with definite rheumatic heart disease, 13 with borderline rheumatic heart disease, and 112 control subjects. None of the subjects had abnormal left ventricular size or ejection fraction. Global longitudinal strain was lower than the 5th percentile in 44% of the subjects with any rheumatic heart disease (p=0.002 versus controls) and 57% of the subjects with definite rheumatic heart disease (p=0.03). The mean absolute strain values were significantly lower when comparing subjects with any rheumatic heart disease with controls (20.4±3.95 versus 22.4±4.35, p=0.025) and subjects with definite rheumatic heart disease with controls (19.9±4.25 versus 22.4±4.35, p=0.033). CONCLUSION Global longitudinal strain is decreased in subjects with rheumatic heart disease in the absence of abnormal systolic function. Larger studies with longer-term follow-up are required to determine whether there is a role for strain to help better understand the pathophysiology of latent rheumatic heart disease.
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26
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Palafox B, Mocumbi AO, Kumar RK, Ali SKM, Kennedy E, Haileamlak A, Watkins D, Petricca K, Wyber R, Timeon P, Mwangi J. The WHF Roadmap for Reducing CV Morbidity and Mortality Through Prevention and Control of RHD. Glob Heart 2017; 12:47-62. [PMID: 28336386 DOI: 10.1016/j.gheart.2016.12.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 12/01/2016] [Indexed: 10/19/2022] Open
Abstract
Rheumatic heart disease (RHD) is a preventable non-communicable condition that disproportionately affects the world's poorest and most vulnerable. The World Heart Federation Roadmap for improved RHD control is a resource designed to help a variety of stakeholders raise the profile of RHD nationally and globally, and provide a framework to guide and support the strengthening of national, regional and global RHD control efforts. The Roadmap identifies the barriers that limit access to and uptake of proven interventions for the prevention and control of RHD. It also highlights a variety of established and promising solutions that may be used to overcome these barriers. As a general guide, the Roadmap is meant to serve as the foundation for the development of tailored plans of action to improve RHD control in specific contexts.
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Affiliation(s)
- Benjamin Palafox
- ECOHOST -The Centre for Health and Social Change, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Ana Olga Mocumbi
- Instituto Nacional de Saúde, Ministério da Saúde and Universidade Eduardo Mondlane, Maputo, Moçambique
| | - R Krishna Kumar
- Amrita Institute of Medical Sciences and Research Centre, Cochin, Kerala, India
| | - Sulafa K M Ali
- University of Khartoum and Sudan Heart Center, Khartoum, Sudan
| | - Elizabeth Kennedy
- Fiji RHD Prevention and Control Project, Ministry of Health and Medical Services and Cure Kids New Zealand, Suva, Fiji
| | | | - David Watkins
- Department of Medicine, University of Washington, Seattle, WA, USA; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Kadia Petricca
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rosemary Wyber
- Telethon Kids Institute, Perth, Western Australia, Australia
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27
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Group A Streptococcus, Acute Rheumatic Fever and Rheumatic Heart Disease: Epidemiology and Clinical Considerations. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:15. [PMID: 28285457 PMCID: PMC5346434 DOI: 10.1007/s11936-017-0513-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OPINION STATEMENT Early recognition of group A streptococcal pharyngitis and appropriate management with benzathine penicillin using local clinical prediction rules together with validated rapi-strep testing when available should be incorporated in primary health care. A directed approach to the differential diagnosis of acute rheumatic fever now includes the concept of low-risk versus medium-to-high risk populations. Initiation of secondary prophylaxis and the establishment of early medium to long-term care plans is a key aspect of the management of ARF. It is a requirement to identify high-risk individuals with RHD such as those with heart failure, pregnant women, and those with severe disease and multiple valve involvement. As penicillin is the mainstay of primary and secondary prevention, further research into penicillin supply chains, alternate preparations and modes of delivery is required.
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Abstract
Primarily affecting the young, rheumatic heart disease (RHD) is a neglected chronic disease commonly causing premature morbidity and mortality among the global poor. Standard clinical prevention and treatment is based on studies from the early antimicrobial era, as research investment halted soon after the virtual eradication of the disease from developed countries. The emergence of new global data on disease burden, new technologies, and a global health equity platform have revitalized interest and investment in RHD. This review surveys past and current evidence for standard RHD diagnosis and treatment, highlighting gaps in knowledge.
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Affiliation(s)
- Shanti Nulu
- Section of Cardiovascular Medicine, Yale School of Medicine, 789 Howard Avenue, New Haven, CT 06519, USA
| | - Gene Bukhman
- Division of Global Health Equity, Brigham and Women's Hospital, 641 Huntington Avenue, Boston, MA 02115, USA; Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA
| | - Gene F Kwan
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115, USA; Section of Cardiovascular Medicine, Boston University Medical Center, Boston University School of Medicine, 88 East Newton Street, D8, Boston, MA 02118, USA.
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Roberts K, Cannon J, Atkinson D, Brown A, Maguire G, Remenyi B, Wheaton G, Geelhoed E, Carapetis JR. Echocardiographic Screening for Rheumatic Heart Disease in Indigenous Australian Children: A Cost-Utility Analysis. J Am Heart Assoc 2017; 6:e004515. [PMID: 28255077 PMCID: PMC5524001 DOI: 10.1161/jaha.116.004515] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/20/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains a leading cause of cardiovascular morbidity and mortality in children and young adults in disadvantaged populations. The emergence of echocardiographic screening provides the opportunity for early disease detection and intervention. Using our own multistate model of RHD progression derived from Australian RHD register data, we performed a cost-utility analysis of echocardiographic screening in indigenous Australian children, with the dual aims of informing policy decisions in Australia and providing a model that could be adapted in other countries. METHODS AND RESULTS We simulated the outcomes of 2 screening strategies, assuming that RHD could be detected 1, 2, or 3 years earlier by screening. Outcomes included reductions in heart failure, surgery, mortality, disability-adjusted life-years, and corresponding costs. Only a strategy of screening all indigenous 5- to 12-year-olds in half of their communities in alternate years was found to be cost-effective (incremental cost-effectiveness ratio less than AU$50 000 per disability-adjusted life-year averted), assuming that RHD can be detected at least 2 years earlier by screening; however, this result was sensitive to a number of assumptions. Additional modeling of improved adherence to secondary prophylaxis alone resulted in dramatic reductions in heart failure, surgery, and death; these outcomes improved even further when combined with screening. CONCLUSIONS Echocardiographic screening for RHD is cost-effective in our context, assuming that RHD can be detected ≥2 years earlier by screening. Our model can be adapted to any other setting but will require local data or acceptable assumptions for model parameters.
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Affiliation(s)
- Kathryn Roberts
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia
| | - Jeffrey Cannon
- Telethon Kids Institute, The University of Western Australia, Subiaco, Western Australia, Australia
| | - David Atkinson
- Rural Clinical School of Western Australia, University of Western Australia, Broome, Western Australia, Australia
| | - Alex Brown
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Graeme Maguire
- Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Bo Remenyi
- Menzies School of Health Research, Royal Darwin Hospital Campus, Darwin, Northern Territory, Australia
| | - Gavin Wheaton
- Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Elizabeth Geelhoed
- Telethon Kids Institute, The University of Western Australia, Subiaco, Western Australia, Australia
| | - Jonathan R Carapetis
- Telethon Kids Institute, The University of Western Australia, Subiaco, Western Australia, Australia
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30
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Mucumbitsi J, Bulwer B, Mutesa L, Ndahindwa V, Semakula M, Rusingiza E, Arya P, Breakey S, Patton-Bolman C, Kaplan EL. Prevalence of rheumatic valvular heart disease in Rwandan school children: echocardiographic evaluation using the World Heart Federation criteria. Cardiovasc J Afr 2017; 28:285-292. [PMID: 28252675 PMCID: PMC5730679 DOI: 10.5830/cvja-2017-007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 01/11/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Rheumatic fever (RF) and rheumatic valvular heart disease (RHD) remain important medical, surgical and public health concerns in many parts of the world, especially in sub-Saharan Africa. However, there are no published data from Rwanda. We performed a RHD prevalence study in a randomly selected sample of Rwandan school children using the 2012 World Heart Federation (WHF) criteria. METHODS Echocardiographic assessment of 2 501 Rwandan school children from 10 schools in the Gasabo district near Kigali was carried out. Resulting data were evaluated by four experienced echocardiographers. Statistical analyses were carried out by statisticians. RESULTS RHD prevalence was 6.8/1 000 children examined (95% CI: 4.2/1 000-10.9/1 000). Seventeen met WHF criteria for RHD, 13 fulfilled criteria for 'borderline' RHD and four were 'definite' RHD. None of these 17 had been previously identified. CONCLUSION These data indicate a significant burden of RHD in Rwanda and support a need for defined public health RF control programmes in children there.
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Affiliation(s)
- J Mucumbitsi
- Rwandan Heart Foundation and Department of Pediatrics, King Faisal Hospital, Kigali, Rwanda
| | - B Bulwer
- Noninvasive Cardiovascular Research, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - L Mutesa
- College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - V Ndahindwa
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - M Semakula
- Rwanda Biomedical Centre, Kigali, Rwanda; Interuniversity Institute for Biostatistical and Statistical Bioinformatics, University of Hasselt, Belgium
| | - E Rusingiza
- School of Medicine and Pharmacy, University of Rwanda, Kigali, Rwanda
| | - P Arya
- Department of Pediatric Cardiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - S Breakey
- Massachusetts General Hospital, Institute of Health Professions, Boston, Massachusetts, USA
| | | | - E L Kaplan
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
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Masiye F, Mayosi B, de Vries J. "I passed the test!" Evidence of diagnostic misconception in the recruitment of population controls for an H3Africa genomic study in Cape Town, South Africa. BMC Med Ethics 2017; 18:12. [PMID: 28202021 PMCID: PMC5311841 DOI: 10.1186/s12910-017-0175-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 02/08/2017] [Indexed: 11/26/2022] Open
Abstract
Background Advances in genetic and genomic research have introduced challenges in obtaining informed consent for research in low and middle-income settings. However, there are only few studies that have explored challenges in obtaining informed consent in genetic and genomic research in Africa and none in South Africa. To start filling this gap, we conducted an empirical study to investigate the efficacy of informed consent procedures for an H3Africa genomic study on Rheumatic Heart Disease (RHDGen) at the University of Cape Town in South Africa. The main aim of the study was to understand ethical challenges in obtaining informed consent in the RHDGen study. Methods We used a qualitative study methodology involving in-depth interviews and participant observations. Our study participants were RHDGen cases (patients), healthy controls and research staff involved in the recruitment of RHDGen cases and controls. In total, we conducted 32 in-depth interviews with RHDGen cases and controls, 2 in-depth interviews with research staff and 57 direct observations of the consent procedures of RHDGen cases and controls. The interviews were conducted in English, audio-recorded and transcribed verbatim. Data were analyzed using thematic content analysis. The study was conducted in 3 sites within Cape Town, South Africa. Results Most healthy controls joined the RHDGen study in order to be screened for rheumatic heart disease (diagnostic misconception). A majority of RHDGen cases decided to join the RHDGen study because of therapeutic misconception. Conclusion The ethical challenges that impacted on obtaining informed consent in the RHDGen study were complex. In this study, the main challenges were diagnostic misconception among RHDGen controls and therapeutic misconception among RHDGen cases.
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Affiliation(s)
- Francis Masiye
- Department of Medicine, University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa. .,University of Malawi College of Medicine, School of Public Health, Centre for Bioethics in Eastern and Southern Africa (CEBESA), Private Bag 360, Chichiri, Blantyre, Malawi.
| | - Bongani Mayosi
- Department of Medicine, University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa
| | - Jantina de Vries
- Department of Medicine, University of Cape Town, Faculty of Health Sciences, Cape Town, South Africa
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32
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Rheumatic Fever. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00052-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Abstract
Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.
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Affiliation(s)
- Scott Dougherty
- Department of Internal Medicine, Ministry of Health, Belau National Hospital, Koror, Republic of Palau
| | - Maziar Khorsandi
- Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Philip Herbst
- Division of Cardiology, Tygerberg Academic Hospital, University of Stellenbosch, Cape Town, South Africa
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Zühlke L, Karthikeyan G, Engel ME, Rangarajan S, Mackie P, Cupido-Katya Mauff B, Islam S, Daniels R, Francis V, Ogendo S, Gitura B, Mondo C, Okello E, Lwabi P, Al-Kebsi MM, Hugo-Hamman C, Sheta SS, Haileamlak A, Daniel W, Goshu DY, Abdissa SG, Desta AG, Shasho BA, Begna DM, ElSayed A, Ibrahim AS, Musuku J, Bode-Thomas F, Yilgwan CC, Amusa GA, Ige O, Okeahialam B, Sutton C, Misra R, Abul Fadl A, Kennedy N, Damasceno A, Sani MU, Ogah OS, Elhassan TOHM, Mocumbi AO, Adeoye AM, Mntla P, Ojji D, Mucumbitsi J, Teo K, Yusuf S, Mayosi BM. Clinical Outcomes in 3343 Children and Adults With Rheumatic Heart Disease From 14 Low- and Middle-Income Countries. Circulation 2016; 134:1456-1466. [DOI: 10.1161/circulationaha.116.024769] [Citation(s) in RCA: 160] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 09/20/2016] [Indexed: 11/16/2022]
Abstract
Background:
There are few contemporary data on the mortality and morbidity associated with rheumatic heart disease or information on their predictors. We report the 2-year follow-up of individuals with rheumatic heart disease from 14 low- and middle-income countries in Africa and Asia.
Methods:
Between January 2010 and November 2012, we enrolled 3343 patients from 25 centers in 14 countries and followed them for 2 years to assess mortality, congestive heart failure, stroke or transient ischemic attack, recurrent acute rheumatic fever, and infective endocarditis.
Results:
Vital status at 24 months was known for 2960 (88.5%) patients. Two-thirds were female. Although patients were young (median age, 28 years; interquartile range, 18–40), the 2-year case fatality rate was high (500 deaths, 16.9%). Mortality rate was 116.3/1000 patient-years in the first year and 65.4/1000 patient-years in the second year. Median age at death was 28.7 years. Independent predictors of death were severe valve disease (hazard ratio [HR], 2.36; 95% confidence interval [CI], 1.80–3.11), congestive heart failure (HR, 2.16; 95% CI, 1.70–2.72), New York Heart Association functional class III/IV (HR, 1.67; 95% CI, 1.32–2.10), atrial fibrillation (HR, 1.40; 95% CI, 1.10–1.78), and older age (HR, 1.02; 95% CI, 1.01–1.02 per year increase) at enrollment. Postprimary education (HR, 0.67; 95% CI, 0.54–0.85) and female sex (HR, 0.65; 95% CI, 0.52–0.80) were associated with lower risk of death. Two hundred and four (6.9%) patients had new congestive heart failure (incidence, 38.42/1000 patient-years), 46 (1.6%) had a stroke or transient ischemic attack (8.45/1000 patient-years), 19 (0.6%) had recurrent acute rheumatic fever (3.49/1000 patient-years), and 20 (0.7%) had infective endocarditis (3.65/1000 patient-years). Previous stroke and older age were independent predictors of stroke/transient ischemic attack or systemic embolism. Patients from low- and lower-middle–income countries had significantly higher age- and sex-adjusted mortality than patients from upper-middle–income countries. Valve surgery was significantly more common in upper-middle–income than in lower-middle– or low-income countries.
Conclusions:
Patients with clinical rheumatic heart disease have high mortality and morbidity despite being young; those from low- and lower-middle–income countries had a poorer prognosis associated with advanced disease and low education. Programs focused on early detection and the treatment of clinical rheumatic heart disease are required to improve outcomes.
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Affiliation(s)
- Liesl Zühlke
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Ganesan Karthikeyan
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Mark E. Engel
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Sumathy Rangarajan
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Pam Mackie
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Blanche Cupido-Katya Mauff
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Shofiqul Islam
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Rezeen Daniels
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Veronica Francis
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Stephen Ogendo
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Bernard Gitura
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Charles Mondo
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Emmy Okello
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Peter Lwabi
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Mohammed M. Al-Kebsi
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Christopher Hugo-Hamman
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Sahar S. Sheta
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Abraham Haileamlak
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Wandimu Daniel
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Dejuma Yadeta Goshu
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Senbeta G. Abdissa
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Araya G. Desta
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Bekele A. Shasho
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Dufera M. Begna
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Ahmed ElSayed
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Ahmed S. Ibrahim
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - John Musuku
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Fidelia Bode-Thomas
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Christopher C. Yilgwan
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Ganiyu A. Amusa
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Olukemi Ige
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Basil Okeahialam
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Christopher Sutton
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Rajeev Misra
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Azza Abul Fadl
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Neil Kennedy
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Albertino Damasceno
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Mahmoud U. Sani
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Okechukwu S. Ogah
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Taiwo OlunugaHuda H. M. Elhassan
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Ana Olga Mocumbi
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Abiodun M. Adeoye
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Phindile Mntla
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Dike Ojji
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Joseph Mucumbitsi
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Koon Teo
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Salim Yusuf
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
| | - Bongani M. Mayosi
- From Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, South Africa (L.Z., M.E.E., B.C., R.D., V.F., B.M.M.); Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa (L.Z., C.H.-H.); Department of Cardiology, All India Institute of Medical Sciences, New Delhi (G.K.); Population Health Research Institute, Hamilton Health Sciences and McMaster University
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Lopes EL, Beaton AZ, Nascimento BR, Tompsett A, Dos Santos JP, Perlman L, Diamantino AC, Oliveira KK, Oliveira CM, Nunes MDCP, Bonisson L, Ribeiro AL, Sable C. Telehealth solutions to enable global collaboration in rheumatic heart disease screening. J Telemed Telecare 2016; 24:101-109. [PMID: 27815494 DOI: 10.1177/1357633x16677902] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The global burden of rheumatic heart disease is nearly 33 million people. Telemedicine, using cloud-server technology, provides an ideal solution for sharing images performed by non-physicians with cardiologists who are experts in rheumatic heart disease. Objective We describe our experience in using telemedicine to support a large rheumatic heart disease outreach screening programme in the Brazilian state of Minas Gerais. Methods The Programa de Rastreamento da Valvopatia Reumática (PROVAR) is a prospective cross-sectional study aimed at gathering epidemiological data on the burden of rheumatic heart disease in Minas Gerais and testing of a non-expert, telemedicine-supported model of outreach rheumatic heart disease screening. The primary goal is to enable expert support of remote rheumatic heart disease outreach through cloud-based sharing of echocardiographic images between Minas Gerais and Washington. Secondary goals include (a) developing and sharing online training modules for non-physicians in echocardiography performance and interpretation and (b) utilising a secure web-based system to share clinical and research data. Results PROVAR included 4615 studies that were performed by non-experts at 21 schools and shared via cloud-telemedicine technology. Latent rheumatic heart disease was found in 251 subjects (4.2% of subjects: 3.7% borderline and 0.5% definite disease). Of the studies, 50% were preformed on full functional echocardiography machines and transmitted via Digital Imaging and Communications in Medicine (DICOM) and 50% were performed on handheld echocardiography machines and transferred via a secure Dropbox connection. The average time between study performance date and interpretation was 10 days. There was 100% success in initial image transfer. Less than 1% of studies performed by non-experts could not be interpreted. Discussion A sustainable, low-cost telehealth model, using task-shifting with non-medical personal in low and middle income countries can improve access to echocardiography for rheumatic heart disease.
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Affiliation(s)
- Eduardo Lv Lopes
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
| | | | | | | | | | | | | | | | - Cassio M Oliveira
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
| | | | - Leonardo Bonisson
- 1 Faculdade de Medicina da Universidade Federal de Minas Gerais, Brazil
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Sahin MS, Yalcin MU, Kocyigit D. Prevalence of rheumatic heart disease in patients with recurrent tonsillitis and elevated anti-streptolysin O titers. Int J Pediatr Otorhinolaryngol 2016; 89:133-5. [PMID: 27619043 DOI: 10.1016/j.ijporl.2016.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/03/2016] [Accepted: 08/04/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Patients with elevated anti-streptolysin O (ASO) titers (ASOT) and recurrent tonsillitis episodes are known to be at higher risk for rheumatic heart disease (RHD). However, there is no data regarding prevalence of RHD in this high risk population. In this study, we aimed to screen ambulatory patients with elevated ASOT and recurrent tonsillitis episodes using echocardiography for identification of RHD. We hypothesized that prevalence of RHD is higher in this patient group compared to general population. METHODS 102 patients (10.33 ± 4.01 years, 50.98% female) who were diagnosed with recurrent tonsillitis and had elevated ASOT were included this study. Echocardiographic evaluation was performed by an experienced cardiologist. RESULTS Echocardiographic examination revealed definite RHD in 2/102 (1.96%) patients and borderline RHD in 3/102 (2.94%) patients. CONCLUSION Our study demonstrates a high prevalence of RHD in patients with recurrent tonsillitis episodes and high ASOT. Screening with echocardiography is beneficial to improve the detection rates of subclinical RHD in such high-risk populations.
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Affiliation(s)
- M S Sahin
- Department of Otolaryngology, Hakkari State Hospital, Hakkari, Turkey
| | - M U Yalcin
- Department of Cardiology, Hakkari State Hospital, Hakkari, Turkey.
| | - D Kocyigit
- Department of Cardiology, Hacettepe University, Faculty of Medicine, Ankara, Turkey
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37
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Saidi T, Douglas TS. Minimally invasive transcatheter aortic valve implantation for the treatment of rheumatic heart disease in developing countries. Expert Rev Med Devices 2016; 13:979-985. [DOI: 10.1080/17434440.2016.1236679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Trust Saidi
- Faculty of Health Sciences, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
| | - Tania S. Douglas
- Faculty of Health Sciences, Division of Biomedical Engineering, University of Cape Town, Cape Town, South Africa
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Evaluation of a focussed protocol for hand-held echocardiography and computer-assisted auscultation in detecting latent rheumatic heart disease in scholars. Cardiol Young 2016; 26:1097-106. [PMID: 26423122 DOI: 10.1017/s1047951115001857] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Introduction Echocardiography is the diagnostic test of choice for latent rheumatic heart disease. The utility of echocardiography for large-scale screening is limited by high cost, complex diagnostic protocols, and time to acquire multiple images. We evaluated the performance of a brief hand-held echocardiography protocol and computer-assisted auscultation in detecting latent rheumatic heart disease with or without pathological murmur. METHODS A total of 27 asymptomatic patients with latent rheumatic heart disease based on the World Heart Federation criteria and 66 healthy controls were examined by standard cardiac auscultation to detect pathological murmur. Hand-held echocardiography using a focussed protocol that utilises one view - that is, the parasternal long-axis view - and one measurement - that is, mitral regurgitant jet - and a computer-assisted auscultation utilising an automated decision tool were performed on all patients. RESULTS The sensitivity and specificity of computer-assisted auscultation in latent rheumatic heart disease were 4% (95% CI 1.0-20.4%) and 93.7% (95% CI 84.5-98.3%), respectively. The sensitivity and specificity of the focussed hand-held echocardiography protocol for definite rheumatic heart disease were 92.3% (95% CI 63.9-99.8%) and 100%, respectively. The test reliability of hand-held echocardiography was 98.7% for definite and 94.7% for borderline disease, and the adjusted diagnostic odds ratios were 1041 and 263.9 for definite and borderline disease, respectively. CONCLUSION Computer-assisted auscultation has extremely low sensitivity but high specificity for pathological murmur in latent rheumatic heart disease. Focussed hand-held echocardiography has fair sensitivity but high specificity and diagnostic utility for definite or borderline rheumatic heart disease in asymptomatic patients.
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Brief Report: Prevalence of Latent Rheumatic Heart Disease Among HIV-Infected Children in Kampala, Uganda. J Acquir Immune Defic Syndr 2016; 71:196-9. [PMID: 26413847 DOI: 10.1097/qai.0000000000000827] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Rheumatic heart disease (RHD) remains highly prevalent in resource-constrained settings around the world, including countries with high rates of HIV/AIDS. Although both are immune-mediated diseases, it is unknown whether HIV modifies the risk or progression of RHD. We performed screening echocardiography to determine the prevalence of latent RHD in 488 HIV-infected children aged 5-18 in Kampala, Uganda. The overall prevalence of borderline/definite RHD was 0.82% (95% confidence interval: 0.26% to 2.23%), which is lower than the published prevalence rates of 1.5%-4% among Ugandan children. There may be protective factors that decrease the risk of RHD in HIV-infected children.
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40
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Engelman D, Kado JH, Reményi B, Colquhoun SM, Carapetis JR, Donath S, Wilson NJ, Steer AC. Focused cardiac ultrasound screening for rheumatic heart disease by briefly trained health workers: a study of diagnostic accuracy. LANCET GLOBAL HEALTH 2016; 4:e386-94. [DOI: 10.1016/s2214-109x(16)30065-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 03/28/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
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The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study. BMC Cardiovasc Disord 2016; 16:46. [PMID: 26892774 PMCID: PMC4759741 DOI: 10.1186/s12872-016-0225-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 02/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Latent rheumatic heart disease (RHD) occurs in asymptomatic individuals with echocardiographic evidence of RHD and no history of acute rheumatic fever. The natural history of latent RHD is unclear but has important clinical and economic implications about whether these children should receive penicillin prophylaxis or not. We performed a 5-year prospective study of this question. METHODS In August 2013 through September 2014, we conducted a follow-up study of latent RHD among school pupils using the World Heart Federation (WHF) echocardiographic criteria. Contingency tables were used to assess progression, persistence or regression of latent RHD. RESULTS Forty two borderline and 13 definite cases of RHD (n 55) were identified, 44 (80%; mean age 13.8 ± 4.0 years; 29 (65.9%) female) of whom were available for echocardiographic examination at a median follow-up of 60.8 months (interquartile range 51.3-63.5). Over the follow-up period, half the participants (n = 23; 52.3%) improved to normal or better WHF category (regressors), a third (n = 14, 31.8%) remained in the same category (persistors), while seven others (15.9%) progressed from borderline to definite RHD (progressors). In total, 21 subjects (47.7%) reverted to a normal status, nine (20.4%) either improved from definite to borderline or remained in the borderline category, and 14 (31.8%) either remained definite or progressed from borderline to a definite status. Two cases (20%) progressed to symptomatic disease. CONCLUSIONS Latent RHD has a variable natural history that ranges from regression to normal in nearly half of cases, to persistence, progression or development of symptoms in the remainder of subjects.
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Engelman D, Kado JH, Reményi B, Colquhoun SM, Carapetis JR, Wilson NJ, Donath S, Steer AC. Screening for rheumatic heart disease: quality and agreement of focused cardiac ultrasound by briefly trained health workers. BMC Cardiovasc Disord 2016; 16:30. [PMID: 26830341 PMCID: PMC4736281 DOI: 10.1186/s12872-016-0205-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/27/2016] [Indexed: 12/22/2022] Open
Abstract
Background Echocardiographic screening for rheumatic heart disease (RHD) has the potential to detect subclinical cases for secondary prevention, but is constrained by inadequate human resources in most settings. Training non-expert health workers to perform focused cardiac ultrasound (FoCUS) may enable screening at a population-level. We aimed to evaluate the quality and agreement of FoCUS for valvular regurgitation by briefly trained health workers. Methods Seven nurses participated in an eight week training program in Fiji. Nurses performed FoCUS on 2018 children aged five to 15 years, and assessed any valvular regurgitation. An experienced pediatric cardiologist assessed the quality of ultrasound images and measured any recorded regurgitation. The assessment of the presence of regurgitation and measurement of the longest jet by the nurse and cardiologist was compared, using the Bland-Altman method. Results The quality of FoCUS overall was adequate for diagnosis in 96.6 %. There was substantial agreement between the cardiologist and the nurses overall on the presence of mitral regurgitation (κ = 0.75) and aortic regurgitation (κ = 0.61) seen in two views. Measurements of mitral regurgitation by nurses and the cardiologist were similar (mean bias 0.01 cm; 95 % limits of agreement −0.64 to 0.66 cm). Conclusions After brief training, health workers with no prior experience in echocardiography can obtain adequate quality images and make a reliable assessment on the presence and extent of valvular regurgitation. Further evaluation of the imaging performance and accuracy of screening by non-expert operators is warranted, as a potential population-level screening strategy in high prevalence settings. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0205-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Engelman
- Centre for International Child Health, University of Melbourne, Parkville, Victoria, Australia. .,Group A Streptococcal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia. .,Royal Children's Hospital, Parkville, Victoria, Australia.
| | - Joseph H Kado
- Department of Paediatrics, Colonial War Memorial Hospital, Suva, Fiji. .,College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.
| | - Bo Reményi
- Royal Darwin Hospital, Tiwi, Northern Territory, Australia. .,Menzies School of Health Research, Casuarina, Northern Territory, Australia.
| | - Samantha M Colquhoun
- Centre for International Child Health, University of Melbourne, Parkville, Victoria, Australia. .,Group A Streptococcal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia. .,Menzies School of Health Research, Casuarina, Northern Territory, Australia.
| | - Jonathan R Carapetis
- Telethon Kids Institute, University of Western Australia, West Perth, Western Australia, Australia. .,Princess Margaret Hospital for Children, Subiaco, Western Australia, Australia.
| | - Nigel J Wilson
- Starship Hospital, Auckland, New Zealand. .,University of Auckland, Auckland, New Zealand.
| | - Susan Donath
- Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia. .,Clinical Epidemiology and Biostatistics Unit, Murdoch Childrens Research Institute, Parkville, Victoria, Australia.
| | - Andrew C Steer
- Centre for International Child Health, University of Melbourne, Parkville, Victoria, Australia. .,Group A Streptococcal Research, Murdoch Childrens Research Institute, Parkville, Victoria, Australia. .,Royal Children's Hospital, Parkville, Victoria, Australia.
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Carapetis JR, Beaton A, Cunningham MW, Guilherme L, Karthikeyan G, Mayosi BM, Sable C, Steer A, Wilson N, Wyber R, Zühlke L. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers 2016; 2:15084. [PMID: 27188830 PMCID: PMC5810582 DOI: 10.1038/nrdp.2015.84] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Acute rheumatic fever (ARF) is the result of an autoimmune response to pharyngitis caused by infection with group A Streptococcus. The long-term damage to cardiac valves caused by ARF, which can result from a single severe episode or from multiple recurrent episodes of the illness, is known as rheumatic heart disease (RHD) and is a notable cause of morbidity and mortality in resource-poor settings around the world. Although our understanding of disease pathogenesis has advanced in recent years, this has not led to dramatic improvements in diagnostic approaches, which are still reliant on clinical features using the Jones Criteria, or treatment practices. Indeed, penicillin has been the mainstay of treatment for decades and there is no other treatment that has been proven to alter the likelihood or the severity of RHD after an episode of ARF. Recent advances - including the use of echocardiographic diagnosis in those with ARF and in screening for early detection of RHD, progress in developing group A streptococcal vaccines and an increased focus on the lived experience of those with RHD and the need to improve quality of life - give cause for optimism that progress will be made in coming years against this neglected disease that affects populations around the world, but is a particular issue for those living in poverty.
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Affiliation(s)
- Jonathan R Carapetis
- Telethon Kids Institute, the University of Western Australia, PO Box 855, West Perth, Western Australia 6872, Australia
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia
| | - Andrea Beaton
- Children's National Health System, Washington, District of Columbia, USA
| | - Madeleine W Cunningham
- Department of Microbiology and Immunology, Biomedical Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Luiza Guilherme
- Heart Institute (InCor), University of São Paulo, School of Medicine, São Paulo, Brazil
- Institute for Immunology Investigation, National Institute for Science and Technology, São Paulo, Brazil
| | - Ganesan Karthikeyan
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Craig Sable
- Children's National Health System, Washington, District of Columbia, USA
| | - Andrew Steer
- Department of Paediatrics, the University of Melbourne, Melbourne, Victoria, Australia
- Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Nigel Wilson
- Green Lane Paediatric and Congenital Cardiac Services, Starship Hospital, Auckland, New Zealand
- Department of Paediatrics, University of Auckland, Auckland, New Zealand
| | - Rosemary Wyber
- Telethon Kids Institute, the University of Western Australia, PO Box 855, West Perth, Western Australia 6872, Australia
| | - Liesl Zühlke
- Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Department of Paediatric Cardiology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
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Ngaïdé AA, Mbaye A, Kane A, Ndiaye MB, Jobe M, Bodian M, Dioum M, Sarr SA, Aw F, Mbakop PS, Ba FG, Gaye ND, Tabane A, Bah MB, Coly SM, Diagne D, Diack B, Diao M, Kane A. Prevalence of rheumatic heart disease in Senegalese school children: a clinical and echocardiographic screening. HEART ASIA 2015; 7:40-5. [PMID: 27326219 DOI: 10.1136/heartasia-2015-010664] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/01/2015] [Accepted: 11/03/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the prevalence of rheumatic heart disease (RHD) in schools (locally referred to as 'daaras') located in the city of Dakar and its suburbs using both clinical examination and echocardiography. METHODS This is a cross-sectional study conducted from 9 August to 24 December 2011 involving 2019 pupils, aged between 5 and 18 years selected from the 16 'daaras' of the Academic Inspectorate (Inspection d'Académie) of the city of Dakar and its suburbs. Anamnestic, clinical and echocardiographic data were collected and entered into a questionnaire designed for the study. The World Heart Federation criteria for echocardiographic diagnosis were used to diagnose RHD. p<0.05 was considered statistically significant in bivariate analysis. RESULTS About 60.1% of the pupils were men and the mean age was 9.7±3.3 years. 10 cases of definite RHD were detected, prevalence being 4.96 per 1000 (95% CI 2.4 to 9.1). This prevalence was five times higher with echocardiographic screening compared with clinical screening. 23 cases (11.4 per 1000) of borderline forms were detected. The populations at risk of definite RHD identified in our study were children over 14 years (p<0.001), those with recurrent sore throat (p=0.003) and those residing in the suburbs of the city of Dakar (p<0.001). CONCLUSION Our study shows a relatively high prevalence of RHD. Reducing its prevalence should focus on the implementation of appropriate policies, targeting at-risk populations and focusing on raising awareness and early detection.
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Affiliation(s)
| | - Alassane Mbaye
- Cardiology Department of Grand Yoff General Hospital , Dakar , Senegal
| | - Adama Kane
- Cardiology Department of Aristide Le Dantec Teaching Hospital, Dakar, Senegal; Unités de Formation et de Recherche (UFR), Santé Université Gaston Berger de Saint-Louis, Saint Louis, Sénégal
| | | | - Modou Jobe
- Cardiology Department of Aristide Le Dantec Teaching Hospital, Dakar, Senegal; Medical Research Council Unit, Atlantic Boulevard, Fajara, The Gambia
| | - Malick Bodian
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Momar Dioum
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Simon Antoine Sarr
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Fatou Aw
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | | | - Fatimata Gatta Ba
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Ngoné Diaba Gaye
- Cardiology Department of Grand Yoff General Hospital , Dakar , Senegal
| | - Alioune Tabane
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | | | - Sarah Mouna Coly
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Dior Diagne
- Cardiology Department of Grand Yoff General Hospital , Dakar , Senegal
| | - Bouna Diack
- Cardiology Department of Grand Yoff General Hospital , Dakar , Senegal
| | - Maboury Diao
- Cardiology Department of Aristide Le Dantec Teaching Hospital , Dakar , Senegal
| | - Abdoul Kane
- Cardiology Department of Grand Yoff General Hospital , Dakar , Senegal
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Affiliation(s)
- Bongani M Mayosi
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town 7925, South Africa.
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46
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Rodriguez-Fernandez R, Amiya R, Wyber R, Widdodow W, Carapetis J. Rheumatic heart disease among adults in a mining community of Papua, Indonesia: findings from an occupational cohort. HEART ASIA 2015; 7:44-48. [PMID: 26294934 PMCID: PMC4537650 DOI: 10.1136/heartasia-2015-010641] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/01/2015] [Accepted: 07/07/2015] [Indexed: 11/22/2022]
Abstract
Background Rheumatic heart disease (RHD) remains a significant cause of cardiovascular morbidity and mortality in developing countries such as Indonesia. Yet, despite being one of the most readily preventable chronic diseases, RHD has received scant research or policy attention, particularly in South-East Asia. Aim To describe the pattern of RHD occurrence in a sample of presenting cases from an occupational cohort in Papua Province, Indonesia. Methods Clinical records of 15 608 mining workers (96.4% men, mean age 36.3±7.4 years) were reviewed retrospectively to identify and extract data on all rheumatic fever (RF) and RHD cases admitted to two hospitals in Papua during 2008–2013. Collected data included basic demographics, employment history and echocardiographic findings. Results 83 RHD cases (95.6% men, mean age 39.6±12.5 years) and 3 RF cases were identified between 2008 and 2013. Increased RHD risk was observed among those aged 35–44 (HR=3.60) and 45–68 (HR=4.46) years relative to the youngest age group (p<0.01). RHD incidence density was 6.84 per 10 000 person years of follow-up. Among cases, mitral stenosis was the most common valvular lesion at initial presentation (41.0%), and 6.0% were multivalvular. Conclusions The prevalence of RHD in Papuan mining workers correlates with adult prevalence data in other populations with a high RHD burden, highlighting RHD as a significant health issue into adulthood. The late stage at which most patients presented points to a strong need for earlier intervention. Both primary and secondary preventive measures must be considered critical tools to prevent and reduce RHD burden, particularly among older age groups.
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Affiliation(s)
- Rodrigo Rodriguez-Fernandez
- Freeport Public Health and Malaria Control , International SOS , Kuala Kencana, Papua , Indonesia ; NCD Asia Pacific Alliance , Tokyo , Japan
| | - Rachel Amiya
- NCD Asia Pacific Alliance , Tokyo , Japan ; Department of Family Nursing , University of Tokyo, Graduate School of Medicine , Tokyo , Japan
| | - Rosemary Wyber
- University of Western Australia, Telethon Kids Institute , Subiaco, Western Australia , Australia
| | - Wishnu Widdodow
- Department of Cardiology and Vascular Medicine , University of Indonesia , Jakarta , Indonesia
| | - Johnathan Carapetis
- University of Western Australia, Telethon Kids Institute , Subiaco, Western Australia , Australia
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Perelini F, Blair N, Wilson N, Farrell A, Aitken A. Family acceptability of school-based echocardiographic screening for rheumatic heart disease in a high-risk population in New Zealand. J Paediatr Child Health 2015; 51:682-8. [PMID: 25756837 DOI: 10.1111/jpc.12829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2014] [Indexed: 11/30/2022]
Abstract
AIM Echocardiographic screening for rheumatic heart disease has been piloted in high-risk areas in New Zealand and internationally, and fulfils most of the criteria for a targeted screening programme. The question of acceptability of rheumatic heart disease screening has not been assessed, and the aim of our study was to assess parental acceptability of a school-based echocardiographic screening programme in a high-risk population in New Zealand. METHODS A post-screening questionnaire was developed to survey parents of children who underwent echocardiographic screening. The families of 34 children with abnormal scan results and a sample of 80 children with normal scan results were surveyed by phone within 4 months of screening. RESULTS Positive results were seen in all survey questions in both normal and abnormal scan groups. All families were supportive of an ongoing screening programme. Of children with abnormal results, 62% of their parents reported that they would treat their child differently; however, all responses were positive health-promoting outcomes. CONCLUSION The study showed strong positive support for school-based echocardiographic screening by a community with high acute rheumatic fever incidence. The study did not detect any short-term negative effects in those with abnormal results. The survey result shows family and community support for the establishment of echocardiographic screening programmes in high acute rheumatic fever areas provided there is adequate infrastructural support.
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Affiliation(s)
- Fiona Perelini
- Department of Paediatrics, Wellington Hospital, Wellington, New Zealand
| | - Nikki Blair
- Department of Paediatrics, Wellington Hospital, Wellington, New Zealand
| | - Nigel Wilson
- Green Lane Pediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand
| | - Alan Farrell
- Department of Paediatrics, Wellington Hospital, Wellington, New Zealand
| | - Andrew Aitken
- Department of Cardiology, Wellington Hospital, Wellington, New Zealand
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Engel ME, Haileamlak A, Zühlke L, Lemmer CE, Nkepu S, van de Wall M, Daniel W, Shung King M, Mayosi BM. Prevalence of rheumatic heart disease in 4720 asymptomatic scholars from South Africa and Ethiopia. Heart 2015; 101:1389-94. [DOI: 10.1136/heartjnl-2015-307444] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 05/12/2015] [Indexed: 01/01/2023] Open
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Godown J, Lu JC, Beaton A, Sable C, Mirembe G, Sanya R, Aliku T, Yu S, Lwabi P, Webb CL, Ensing GJ. Handheld echocardiography versus auscultation for detection of rheumatic heart disease. Pediatrics 2015; 135:e939-44. [PMID: 25780068 DOI: 10.1542/peds.2014-2774] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) remains a major public health concern in developing countries, and routine screening has the potential to improve outcomes. Standard portable echocardiography (STAND) is far more sensitive than auscultation for the detection of RHD but remains cost-prohibitive in resource-limited settings. Handheld echocardiography (HAND) is a lower-cost alternative. The purpose of this study was to assess the incremental value of HAND over auscultation to identify RHD. METHODS RHD screening was completed for schoolchildren in Gulu, Uganda, by using STAND performed by experienced echocardiographers. Any child with mitral or aortic regurgitation or stenosis plus a randomly selected group of children with normal STAND findings underwent HAND and auscultation. STAND and HAND studies were interpreted by 6 experienced cardiologists using the 2012 World Heart Federation criteria. Sensitivity and specificity of HAND and auscultation for the detection of RHD and pathologic mitral or aortic regurgitation were calculated by using STAND as the gold standard. RESULTS Of 4773 children who underwent screening with STAND, a subgroup of 1317 children underwent HAND and auscultation. Auscultation had uniformly poor sensitivity for the detection of RHD or valve disease. Sensitivity was significantly improved by using HAND compared with auscultation for the detection of definite RHD (97.8% vs 22.2%), borderline or definite RHD (78.4% vs 16.4%), and pathologic aortic insufficiency (81.8% vs 13.6%). CONCLUSIONS Auscultation alone is a poor screening test for RHD. HAND significantly improves detection of RHD and may be a cost-effective screening strategy for RHD in resource-limited settings.
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Affiliation(s)
- Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee;
| | - Jimmy C Lu
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Andrea Beaton
- Division of Pediatric Cardiology, Children's National Medical Center, Washington, District of Columbia
| | - Craig Sable
- Division of Pediatric Cardiology, Children's National Medical Center, Washington, District of Columbia
| | | | | | | | - Sunkyung Yu
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | - Catherine L Webb
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Gregory J Ensing
- Division of Pediatric Cardiology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Affiliation(s)
- Mohammed R Essop
- From the Division of Cardiology, CH-Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa.
| | - Ferande Peters
- From the Division of Cardiology, CH-Baragwanath Hospital and University of the Witwatersrand, Johannesburg, South Africa
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