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Alberio AMQ, Pieroni F, Di Gangi A, Cappelli S, Bini G, Abu-Rumeileh S, Orsini A, Bonuccelli A, Peroni D, Assanta N, Gaggiano C, Simonini G, Consolini R. Toward the Knowledge of the Epidemiological Impact of Acute Rheumatic Fever in Italy. Front Pediatr 2021; 9:746505. [PMID: 34976887 PMCID: PMC8714836 DOI: 10.3389/fped.2021.746505] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: To estimate the incidence of Acute Rheumatic Fever (ARF) in Tuscany, a region of Central Italy, evaluating the epidemiological impact of the new diagnostic guidelines, and to analyse our outcomes in the context of the Italian overview. Methods: A multicenter and retrospective study was conducted involving children <18 years old living in Tuscany and diagnosed in the period between 2010 and 2019. Two groups were established based on the new diagnostic criteria: High-Risk (HR) group patients, n = 29 and Low-Risk group patients, n = 96. Results: ARF annual incidence ranged from 0.91 to 7.33 out of 100,000 children in the analyzed period, with peak of incidence registered in 2019. The application of HR criteria led to an increase of ARF diagnosis of 30%. Among the overall cohort joint involvement was the most represented criteria (68%), followed by carditis (58%). High prevalence of subclinical carditis was observed (59%). Conclusions: Tuscany should be considered an HR geographic area and HR criteria should be used for ARF diagnosis in this region.
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Affiliation(s)
| | - Filippo Pieroni
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Di Gangi
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Susanna Cappelli
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Bini
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sarah Abu-Rumeileh
- Rheumatology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Alessandro Orsini
- Pediatrics Unit, Section of Pediatric Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alice Bonuccelli
- Pediatrics Unit, Section of Pediatric Neurology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Diego Peroni
- Pediatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nadia Assanta
- Heart Hospital-G. Monasterio Tuscany Foundation, Massa, Italy
| | - Carla Gaggiano
- Clinical Pediatrics, Department of Molecular Medicine and Development, University of Siena, Siena, Italy
| | - Gabriele Simonini
- Rheumatology Unit, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Rita Consolini
- Pediatrics Unit, Section of Clinical and Laboratory Immunology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Webb RH, Culliford-Semmens N, Sidhu K, Wilson NJ. Normal echocardiographic mitral and aortic valve thickness in children. HEART ASIA 2017; 9:70-75. [PMID: 28405228 DOI: 10.1136/heartasia-2016-010872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We aimed to define the normal range of aortic and mitral valve thickness in healthy schoolchildren from a high prevalence rheumatic heart disease (RHD) region, using a standardised protocol for imaging and measurement. METHODS Measurements were performed in 288 children without RHD. Anterior mitral valve leaflet (AMVL) thickness measurements were performed at the midpoint and tip of the leaflet in the parasternal long axis (PSLA) in diastole, when the AMVL was approximately parallel to the ventricular septum. Thickness of the aortic valve was measured from PSLA imaging in systole when the leaflets were at maximum excursion. The right coronary and non-coronary closure lines of the aortic valve were measured in diastole in parasternal short axis (PSSA) imaging. Results were compared with 51 children with RHD classified by World Heart Federation diagnostic criteria. RESULTS In normal children, median AMVL tip thickness was 2.0 mm (IQR 1.7-2.4) and median AMVL midpoint thickness 2.0 mm (IQR 1.7-2.4). The median aortic valve thickness was 1.5 mm (IQR 1.3-1.6) in the PSLA view and 1.4 mm (IQR 1.2-1.6) in the PSSA view. The interclass correlation coefficient for the AMVL tip was 0.85 (0.71 to 0.92) and for the AMVL midpoint was 0.77 (0.54 to 0.87). CONCLUSIONS We have described a standardised method for mitral and aortic valve measurement in children which is objective and reproducible. Normal ranges of left heart valve thickness in a high prevalence RHD population are established. These results provide a reference range for school-age children in high prevalence RHD regions undergoing echocardiographic screening.
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Affiliation(s)
- Rachel H Webb
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
| | - Nicola Culliford-Semmens
- Green Lane Paediatric and Congenital Cardiac Services , Starship Children's Hospital , Auckland , New Zealand
| | - Karishma Sidhu
- Green Lane Cardiovascular Services , Auckland City Hospital , Auckland , New Zealand
| | - Nigel J Wilson
- Green Lane Paediatric and Congenital Cardiac Services , Starship Children's Hospital , Auckland , New Zealand
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Basturk A, Oztarhan K, Kavuncuoğlu S, Polat C. Significance of silent carditis and investigation of follow-up signs in acute rheumatic fever. Future Cardiol 2016; 12:281-7. [PMID: 27097234 DOI: 10.2217/fca.16.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM This study aimed to demonstrate the importance of ECHO in the diagnosis and long-term follow-up of silent carditis. MATERIAL & METHODS This study included 182 (157 arthritis; 25 chorea) patients out of 214 patients who had been diagnosed with acute rheumatic fever for the first time. All of the patients were scanned with ECHO between specific intervals. RESULTS While there was no recovery observed in isolated aortic insufficiency during long-term follow-up, recovery in isolated mitral insufficiency was found. As the follow-up time of the mitral and aortic insufficiencies became longer, there was an increase in recovery in aortic insufficiency. CONCLUSION Follow-up results of silent carditis support that ECHO should be among the major criteria used to diagnose rheumatic carditis.
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Affiliation(s)
- Ahmet Basturk
- Department of Pediatric Gastroenterology, Faculty of Medicine, Akdeniz University, Dumlupinar Bulvari-Campus 07059, Antalya, Turkey
| | - Kazim Oztarhan
- Department of Pediatrics, Istanbul Kanuni Sultan Süleyman Research & Teaching Hospital, Istanbul, Turkey
| | - Sultan Kavuncuoğlu
- Department of Pediatrics, Istanbul Kanuni Sultan Süleyman Research & Teaching Hospital, Istanbul, Turkey
| | - Cemal Polat
- Department of Biochemistry, Public Health Laboratory, Kütahya, Turkey
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Gewitz MH, Baltimore RS, Tani LY, Sable CA, Shulman ST, Carapetis J, Remenyi B, Taubert KA, Bolger AF, Beerman L, Mayosi BM, Beaton A, Pandian NG, Kaplan EL. Revision of the Jones Criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation 2015; 131:1806-18. [PMID: 25908771 DOI: 10.1161/cir.0000000000000205] [Citation(s) in RCA: 375] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Acute rheumatic fever remains a serious healthcare concern for the majority of the world's population despite its decline in incidence in Europe and North America. The goal of this statement was to review the historic Jones criteria used to diagnose acute rheumatic fever in the context of the current epidemiology of the disease and to update those criteria to also take into account recent evidence supporting the use of Doppler echocardiography in the diagnosis of carditis as a major manifestation of acute rheumatic fever. METHODS AND RESULTS To achieve this goal, the American Heart Association's Council on Cardiovascular Disease in the Young and its Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee organized a writing group to comprehensively review and evaluate the impact of population-specific differences in acute rheumatic fever presentation and changes in presentation that can result from the now worldwide availability of nonsteroidal anti-inflammatory drugs. In addition, a methodological assessment of the numerous published studies that support the use of Doppler echocardiography as a means to diagnose cardiac involvement in acute rheumatic fever, even when overt clinical findings are not apparent, was undertaken to determine the evidence basis for defining subclinical carditis and including it as a major criterion of the Jones criteria. This effort has resulted in the first substantial revision to the Jones criteria by the American Heart Association since 1992 and the first application of the Classification of Recommendations and Levels of Evidence categories developed by the American College of Cardiology/American Heart Association to the Jones criteria. CONCLUSIONS This revision of the Jones criteria now brings them into closer alignment with other international guidelines for the diagnosis of acute rheumatic fever by defining high-risk populations, recognizing variability in clinical presentation in these high-risk populations, and including Doppler echocardiography as a tool to diagnose cardiac involvement.
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Pekpak E, Atalay S, Karadeniz C, Demir F, Tutar E, Uçar T. Rheumatic silent carditis: echocardiographic diagnosis and prognosis of long-term follow up. Pediatr Int 2013; 55:685-9. [PMID: 23789715 DOI: 10.1111/ped.12163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 02/17/2013] [Accepted: 06/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rheumatic fever and rheumatic heart disease continue to be an important public health problem in developing countries. Doppler echocardiography is now widely used for early detection and recurrence of clinical evident carditis (CC) and silent (subclinical) carditis (SC). The aim of this study was to determine the frequency of SC and to compare clinical and echocardiographic features of CC and SC. METHODS A total of 156 consecutive patients diagnosed with acute rheumatic fever were included in the study. The patients without clinical evidence but with echocardiographic findings of carditis were diagnosed as having SC. RESULTS Acute rheumatic fever was diagnosed in 156 patients, and 103 of these (66%) had carditis. The prevalence of SC was 28.2% among these 103 patients. Seventy-four of the patients with carditis were followed up for >1 year, and 20 of those had SC. Valvular regurgitation disappeared completely in 18.5% and improved in 45.5% of the CC patients. The recovery and improvement rates in the SC group were 15% and 30%, respectively. CONCLUSION It is suggested that Doppler echocardiography be performed in all patients with suspected acute rheumatic fever for early detection of SC. Echocardiography should be used as a diagnostic criterion in order not to miss a diagnosis of SC.
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Affiliation(s)
- Esra Pekpak
- Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
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Zühlke LJ, Steer AC. Estimates of the Global Burden of Rheumatic Heart Disease. Glob Heart 2013; 8:189-95. [DOI: 10.1016/j.gheart.2013.08.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Revised: 08/12/2013] [Accepted: 08/13/2013] [Indexed: 10/26/2022] Open
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Kramoh KE, N'Goran YNK, Aké-Traboulsi E, Konin KC, Boka BC, Koffi DBJ, Sow TM, Mandah YC, Kakou-Guikahue M. [Acute rheumatic carditis in Ivory Coast: changes in prevalence during the decade 2000-2009]. Ann Cardiol Angeiol (Paris) 2013; 62:34-37. [PMID: 22560250 DOI: 10.1016/j.ancard.2012.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Accepted: 03/02/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND Rheumatic fever and acute rheumatic carditis (ARC), though now rare in developed countries, are the main cause of acquired heart disease in children and young adults and remain endemic in developing countries. This study aims to establish the current prevalence of ARC in Ivory Coast. PATIENTS AND METHODS A cross-sectional retrospective study was performed between January 2000 and December 2009 in the pediatric wards of the three university hospitals in Abidjan and in the Institute of Cardiology of Abidjan. It included all patients whose final diagnosis was ARC. RESULTS There were 126 patients of which 57.1% were female. The mean age was 15 ± 6.7 years (range: 4 to 28 years). The average annual prevalence was 12.6 cases, with two peaks observed during the years 2004 (27 cases) and 2005 (20 cases). The hospital prevalence of ARC in the 10-year period was 1.1‰ which is less than in previous decades. The principal presentation leading to discovery of the ARC was heart failure (68.9%). This symptom was due to significant valvular regurgitation with dilatation of the cardiac chambers observed in 65.9%. Mitral regurgitation was the main lesion observed (87.3%). Apart from the cases of isolated pericarditis and three cases of mild mitral regurgitation, all other patients were suffering from valvular lesions as a result of previous rheumatic fever. CONCLUSION A decrease in the hospital prevalence of ARC was observed. However the cases that were seen were diagnosed late and had a tendency to be severe.
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Affiliation(s)
- K E Kramoh
- Institut de cardiologie d'Abidjan, BP V 206 Abidjan, Côte d'Ivoire.
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Echocardiographic Screening for Subclinical Rheumatic Heart Disease Remains a Research Tool Pending Studies of Impact on Prognosis. Curr Cardiol Rep 2013; 15:343. [DOI: 10.1007/s11886-012-0343-1] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Reményi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, Lawrenson J, Maguire G, Marijon E, Mirabel M, Mocumbi AO, Mota C, Paar J, Saxena A, Scheel J, Stirling J, Viali S, Balekundri VI, Wheaton G, Zühlke L, Carapetis J. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline. Nat Rev Cardiol 2012; 9:297-309. [PMID: 22371105 DOI: 10.1038/nrcardio.2012.7] [Citation(s) in RCA: 505] [Impact Index Per Article: 42.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: 'definite RHD', 'borderline RHD', and 'normal'. Four subcategories of 'definite RHD' and three subcategories of 'borderline RHD' exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control.
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Affiliation(s)
- Bo Reményi
- Green Lane Pediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand.
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Pastore S, De Cunto A, Benettoni A, Berton E, Taddio A, Lepore L. The resurgence of rheumatic fever in a developed country area: the role of echocardiography. Rheumatology (Oxford) 2010; 50:396-400. [PMID: 21047802 DOI: 10.1093/rheumatology/keq290] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The annual incidence of ARF ranges from 5 to 51/100, 000 population worldwide in the 5- to 15-year age group. In the past, there was a decline in the incidence of ARF; however, focal outbreaks have been reported. This study evaluated the incidence of ARF in 2007-08 in a region of a developed country compared with the previous decade. METHODS A retrospective review of all admission records for ARF in Trieste between January 2007 and December 2008 was undertaken. The diagnosis of ARF was established by the Jones criteria according to the 1992 revision. RESULTS Between January 2007 and December 2008: 13 cases of ARF were recorded, 11 females and 2 males. The estimated incidence was 23 and 27/100, 000 population new cases each year, respectively, in the 5- to 15-year age group. Migratory polyarthritis occurred in 6/13, chorea in 7/13 and clinical carditis in 5/13 cases. Five out of 13 patients had only echocardiographic abnormalities, with no clinical cardiac manifestations. Another two patients did not fulfil diagnostic criteria for ARF, presenting with only three minor criteria, but they revealed silent carditis at echocardiography evaluation. During the follow-up, in one case the carditis receded and in the other it significantly improved. CONCLUSIONS Our experience underlines that ARF has not yet disappeared in industrialized countries. We observed a high incidence of chorea, always associated with mild carditis. Echocardiographic assessment should be routinely performed in all patients with suspected ARF in order to identify those subclinical cases of valvulitis that would otherwise pass undiagnosed without receiving proper prophylaxis.
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Affiliation(s)
- Serena Pastore
- Department of Pediatrics, IRCCS Burlo Garofolo - University of Trieste, Italy.
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Echocardiography and subclinical carditis: guidelines that increase sensitivity for acute rheumatic fever. Cardiol Young 2008; 18:565-8. [PMID: 18950543 DOI: 10.1017/s1047951108003211] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Beg A, Sadiq M. Subclinical valvulitis in children with acute rheumatic Fever. Pediatr Cardiol 2008; 29:619-23. [PMID: 18157644 DOI: 10.1007/s00246-007-9173-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2007] [Revised: 10/19/2007] [Accepted: 11/18/2007] [Indexed: 10/22/2022]
Abstract
Doppler echocardiography facility is now available in most parts of the world and its routine use for the initial diagnosis of acute rheumatic fever (ARF) might enhance its early detection and, hence, prevention of rheumatic recurrences. To add to the existing evidence and to reemphasize the need of including echocardiography as a diagnostic criterion for ARF, we investigated the pattern and prevalence of subclinical valvulitis by Doppler echocardiography in patients with ARF manifesting as either pure chorea or isolated arthritis but without clinical signs of carditis. This prospective study was carried out in a single center over a period of 6 months (June to December 2006). Thirty patients with ARF, 16 males and 14 females, aged 4-15 years (mean: 10 +/- 3.2) presenting with either chorea or isolated arthritis were included by convenience sampling. Evidence of carditis as detected by echocardiography was present in 21 patients (70%). Chorea was the presenting feature in 19 patients (63%), followed by migratory polyarthritis in 11 (37%). Among patients with chorea, 13 (68%) had evidence of carditis. Mitral regurgitation (MR) was present in all 13, being isolated in 11 and with aortic regurgitation (AR) in 2 patients. In patients with migratory polyarthritis, 8 (73%) had evidence of carditis, all with isolated MR. Echocardiography detected subclinical valvulitis in at least 70% of patients with ARF presenting with either rheumatic chorea or migratory arthritis but no clinical evidence of carditis. MR was the predominant lesion present in all patients either in isolation (90%) or in combination with AR (10%). We suggest that Doppler echocardiography be performed in all patients with suspected ARF and evidence of subclinical valvulitis be used as a diagnostic criterion.
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Affiliation(s)
- Ahsan Beg
- Department of Paediatric Cardiology, The Children's Hospital/The Institute of Child Health, Lahore, Pakistan
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