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Morais H, da Silva Ferreira H. Prevalence of rheumatic heart disease diagnosed according to the echocardiographic criteria of the World Heart Federation in Africa: A systematic review and meta-analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00494-9. [PMID: 38777673 DOI: 10.1016/j.carrev.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/02/2024] [Accepted: 05/18/2024] [Indexed: 05/25/2024]
Abstract
Rheumatic heart disease (RHD) is a chronic complication arising from acute rheumatic fever (ARF), an autoimmune response triggered by group A streptococcal infection. It primarily affects children and young adults in developing countries. RHD continues to show substantial global heterogeneity. Socioeconomic factors lead the virtual disappearance of RHD in industrialized countries with the introduction of penicillin. By contrast, RHD is still endemic in Africa, Asia, South America, and developing communities of Australasia. We provide an estimate of the current prevalence of latent RHD in Africa using the echocardiographic diagnostic criteria of the World Heart Federation (WHF). Systematic review and meta-analysis of 21 studies reporting the prevalence of RHD, encompassing 40.639 patients. Estimated prevalence of RHD was 25.5 cases per 1000 population (P ≤0.02; 95 % CI, 18.1-32.9 per 1000): definite RHD 13.1 cases per 1000 population (95 % CI, 7.7-18.5 per 1000): and borderline 12,4 cases per 1000 population (95 % CI, 7.7-17.0 per 1000). The prevalence of definite RHD was a significantly higher in adults (M = 28.2, SD = 6.1) compared to children (M = 10.3, SD = 9.2), t(17) = 2.6, p = .0179. Prevalence of definite RHD in schools was 7,92 cases per 1000 population (95 % CI, 4,49-11,35 per 1000) and in community was 26,17 cases per 1000 population (95 % CI, 12,27-40,06 per 1000). This meta-analysis may have produced a better estimate of the prevalence of RHD in Africa using only studies performed according to the 2012 WHF, and clearly showed the high prevalence of RHD in the community and in adults.
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Affiliation(s)
- Humberto Morais
- Department of Cardiology, Hospital Militar Principal/Instituto Superior, Luanda, Angola
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Kaltenborn ZP, Zewde A, Kirsch JD, Yates M, Tessier KM, Nemec E, Johannsen RA. The Impact of a Handheld Ultrasound Device in a Rheumatic Heart Disease Screening Program in Ethiopia. POCUS JOURNAL 2023; 8:193-201. [PMID: 38099177 PMCID: PMC10721305 DOI: 10.24908/pocus.v8i2.16390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Background: Rheumatic heart disease (RHD) affects 33 million people in low and middle income countries and is the leading cause of cardiovascular death among children and young adults. Penicillin prophylaxis prevents progression in asymptomatic disease. Efforts to expand echocardiographic screening are focusing on simplified protocols, non-physician ultrasonographers, and portable ultrasound devices, including handheld ultrasound. Recent advances support the use of single-view screening protocols. With the increasing availability and low cost of handheld devices, studies are needed to evaluate their performance in these settings. Methods: We conducted a retrospective study comparing the rate of screen positive ultrasounds before and after the use of a handheld ultrasound in an RHD screening program in Ethiopia. We also performed a cross-sectional device comparison in 19 at-risk school-children participating in the rheumatic heart disease screening program. Results: Between March of 2019 and January of 2022, 6631 children were screened for rheumatic heart disease of whom 4029 were screened after the introduction of a handheld device. Before the use of the handheld ultrasound device 291 (11.2%) children had a screen positive ultrasounds compared with 167 (4.1%) afterwards (p<0.001). We also compared non-expert to expert interpretation by device and found a significant difference in interpretation for the Lumify (p=0.025). There was a trend towards shorter jet length by color Doppler in the handheld ultrasound device for both expert and non-expert review. Conclusions: Our study highlights that the screen-positive rate in a RHD screening program is influenced by the device being used in the screening process.
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Affiliation(s)
- Zachary P Kaltenborn
- Departments of General Internal Medicine and Pediatrics, University of Minnesota Medical SchoolMinneapolis , MNUSA
| | - Anteneh Zewde
- Department of General Internal Medicine, University of Minnesota Medical SchoolMinneapolis, MNUSA
| | - Jonathan D Kirsch
- Department of General Internal Medicine, University of Minnesota Medical SchoolMinneapolis, MNUSA
| | | | - Katelyn M Tessier
- Masonic Cancer Center, Division of Cardiology, University of Minnesota, Biostatistics CoreMinneapolis, MNUSA
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Mebrahtom G, Hailay A, Aberhe W, Zereabruk K, Haile T. Rheumatic Heart Disease in East Africa: A Systematic Review and Meta-Analysis. Int J Rheumatol 2023; 2023:8834443. [PMID: 37767221 PMCID: PMC10522432 DOI: 10.1155/2023/8834443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 09/29/2023] Open
Abstract
Background Despite being a grave problem, there is little information on rheumatic heart disease's prevalence in East Africa. Therefore, the purpose of this systematic review and meta-analysis was to estimate the pooled prevalence of rheumatic heart disease in East Africa. Materials and Methods A computerized systematic search of using multiple database searching engines was performed in search of relevant English articles from the inception of the databases to December 2019. It was done in accordance with the preferred reporting items for systematic review and meta-analysis (PRISMA) standard. The funnel plot was used to assess publication bias. R and RStudio for Windows were used for all statistical analysis. The random-effect model was used for calculating the pooled estimate of the prevalence of rheumatic heart disease. Results The database search retrieved 1073 papers, and 80 articles (78 cross-sectional and two cohort study designs) with a total of 184575 individuals were found to be appropriate for the review. In East Africa, the overall prevalence of rheumatic heart disease was 14.67% (95% CI: 13.99% to 15.35%). In Ethiopia, Uganda, Tanzania, and Sudan, respectively, the subgroup analysis of rheumatic heart disease pooled prevalence was 22% (95% CI: 13% to 36%), 11% (95%t CI: 5% to 20%), 9% (95%t CI: 5% to 16%), and 3% (95%t CI: 1% to 10%), while the pooled prevalence of rheumatic heart disease in adults was 20% (95% CI: 12% to 30%), and in children, it was 4% (95% CI: 2% to 8%). Conclusions From this report, the prevalence of rheumatic heart disease in East Africa is very high, affecting about one in seven people. Therefore, future strategies should emphasize preventive measures at appropriate times to minimize the burden of this type of preventable heart disease.
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Affiliation(s)
- Guesh Mebrahtom
- Department of Adult Health Nursing, School of Nursing, Aksum University, Aksum, Ethiopia
| | - Abrha Hailay
- Department of Adult Health Nursing, School of Nursing, Aksum University, Aksum, Ethiopia
| | - Woldu Aberhe
- Department of Adult Health Nursing, School of Nursing, Aksum University, Aksum, Ethiopia
| | - Kidane Zereabruk
- Department of Adult Health Nursing, School of Nursing, Aksum University, Aksum, Ethiopia
| | - Teklehaimanot Haile
- Department of Maternity and Neonatal Nursing, School of Nursing, Aksum University, Aksum, Ethiopia
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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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Olds P, Kachimanga C, Talama G, Mailosi B, Ndarama E, Totten J, Musinguzi N, Hangiwa D, Bukhman G, Wroe EB. Non-communicable disease burden among inpatients at a rural district hospital in Malawi. Glob Health Res Policy 2023; 8:4. [PMID: 36810123 PMCID: PMC9945353 DOI: 10.1186/s41256-023-00289-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/09/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) is high in Malawi. However, resources and training for NCD care remain scarce, especially in rural hospitals. Current care for NCDs in the developing world focuses on the WHO's traditional 4 × 4 set. However, we do not know the full burden of NCDs outside of that scope, like neurological disease, psychiatric illness, sickle cell disease, and trauma. The goal of this study was to understand the burden of NCDs among inpatients in a rural district hospital in Malawi. We broadened our definition of NCDs beyond the traditional 4 × 4 set of NCDs, and included neurological disease, psychiatric illness, sickle cell disease, and trauma. METHODS We conducted a retrospective chart review of all inpatients who were admitted to the Neno District Hospital between January 2017 and October 2018. We broke patients down by age, date of admission, type, and number of NCD diagnoses, and HIV status, and constructed multivariate regression models for length of stay and in-hospital mortality. RESULTS Of 2239 total visits, 27.5% were patients with NCDs. Patients with NCDs were older (37.6 vs 19.7 years, p < 0.001) and made up 40.2% of total hospital time. We also found two distinct populations of NCD patients. The first were patients 40 years and older with primary diagnoses of hypertension, heart failure, cancer, and stroke. The second were patients under 40 years old with primary diagnoses of mental health conditions, burns, epilepsy, and asthma. We also found significant trauma burden, accounting for 40% of all NCD visits. In multivariate analysis, carrying a medical NCD diagnosis was associated with longer length of stay (coefficient 5.2, p < 0.001) and a higher risk of in-hospital mortality (OR 1.9, p = 0.03). Burn patients also had significantly longer length of stay (coefficient 11.6, p < 0.001). CONCLUSIONS There is a significant burden of NCDs in a rural hospital in Malawi, including those outside of the traditional 4 × 4 set. We also found high rates of NCDs in the younger population (under 40 years of age). Hospitals must be equipped with adequate resources and training to meet this burden of disease.
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Affiliation(s)
- Peter Olds
- Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | | | | | | | - Enoch Ndarama
- grid.415722.70000 0004 0598 3405Ministry of Health and Population, Lilongwe, Malawi
| | - Jodie Totten
- grid.34477.330000000122986657Department of Emergency Medicine, University of Washington, Seattle, WA USA
| | - Nicholas Musinguzi
- grid.33440.300000 0001 0232 6272Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Gene Bukhman
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,Partners in Health, Neno, Malawi ,grid.62560.370000 0004 0378 8294Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XProgram in Global NCDs and Social Change, Deparment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
| | - Emily B. Wroe
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA ,Partners in Health, Neno, Malawi ,grid.62560.370000 0004 0378 8294Center for Integration Science, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, MA USA ,grid.38142.3c000000041936754XProgram in Global NCDs and Social Change, Deparment of Global Health and Social Medicine, Harvard Medical School, Boston, MA USA
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Moher JM, Morales-Pérez L, Chiume M, Crouse HL, Mgusha Y, Betchani F, D'Amico BM. Point-of-care ultrasound needs assessment in a paediatric acute care setting in Malawi. Trop Med Int Health 2023; 28:17-24. [PMID: 36416491 DOI: 10.1111/tmi.13832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To describe the use of point-of-care ultrasound (POCUS) in an acute-care paediatric setting in Malawi, including clinical indications, types of examinations and frequency of positive findings. METHODS Retrospective, cross-sectional study of a convenience sample of POCUS examinations performed in one tertiary referral hospital in Lilongwe, Malawi over 1 year. POCUS examinations were performed by Paediatric Emergency Medicine physician consultants as part of routine clinical practice and at the request of local clinicians. Images were saved along with the clinical indication and physician interpretation for quality review. Ultrasounds performed by the radiology department and those examinations that were technically faulty, missing clinical application or interpretation were excluded. RESULTS In total, 225 ultrasounds of 142 patients were analysed. The most common clinical indications for which examinations were completed were respiratory distress (23%), oedema (11.7%) and shock/arrest (6.2%). The most common examinations performed were cardiac (41.8%) and lung (15.1%), focused assessment with sonography in trauma (FAST; 12.9%) and ultrasound-guided procedural examinations (9.8%). Pathology was identified in 68% of non-procedural examinations. Cardiac examinations demonstrated significant pathology, including reduced cardiac function (12.8%), gross cardiac structural abnormality (11.8%) and pericardial effusion (10.3%). CONCLUSIONS POCUS was used for both clinical decision-making and procedural guidance, and a significant number of POCUS examinations yielded positive findings. Thus, we propose that cardiopulmonary, FAST and procedural examinations should be considered in future for the POCUS curriculum in this setting.
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Affiliation(s)
- Justin M Moher
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | | | - Msandeni Chiume
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Heather L Crouse
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Yamikani Mgusha
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Fanuel Betchani
- Department of Pediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Beth M D'Amico
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Edwards LA, Feng F, Iqbal M, Fu Y, Sanyahumbi A, Hao S, McElhinney DB, Ling XB, Sable C, Luo J. Machine Learning for Pediatric Echocardiographic Mitral Regurgitation Detection. J Am Soc Echocardiogr 2023; 36:96-104.e4. [PMID: 36191670 DOI: 10.1016/j.echo.2022.09.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Echocardiography-based screening for valvular disease in at-risk asymptomatic children can result in early diagnosis. These screening programs, however, are resource intensive and may not be feasible in many resource-limited settings. Automated echocardiographic diagnosis may enable more widespread echocardiographic screening, early diagnosis, and improved outcomes. In this feasibility study, the authors sought to build a machine learning model capable of identifying mitral regurgitation (MR) on echocardiography. METHODS Echocardiograms were labeled by clip for view and by frame for the presence of MR. The labeled data were used to build two convolutional neural networks to perform the stepwise tasks of classifying the clips (1) by view and (2) by the presence of any MR, including physiologic, in parasternal long-axis color Doppler views. The view classification model was developed using 66,330 frames, and model performance was evaluated using a hold-out testing data set with 45 echocardiograms (11,730 frames). The MR detection model was developed using 938 frames, and model performance was evaluated using a hold-out testing data set with 42 echocardiograms (182 frames). Metrics to evaluate model performance included accuracy, precision, recall, F1 score (average of precision and recall, ranging from 0 to 1, with 1 suggesting perfect precision and recall), and receiver operating characteristic analysis. RESULTS For the parasternal long-axis view with color Doppler, the view classification convolutional neural network achieved an F1 score of 0.97. The MR detection convolutional neural network achieved testing accuracy of 0.86 and an area under the receiver operating characteristic curve of 0.91. CONCLUSIONS A machine learning model is capable of discerning MR on transthoracic echocardiography. This is an encouraging step toward machine learning-based diagnosis of valvular heart disease on pediatric echocardiography.
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Affiliation(s)
- Lindsay A Edwards
- Department of Pediatrics, Seattle Children's Hospital, Seattle, Washington
| | - Fei Feng
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Mehreen Iqbal
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Yong Fu
- University of Michigan-Shanghai Jiao Tong University Joint Institute, Shanghai Jiao Tong University, Shanghai, China
| | - Amy Sanyahumbi
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Shiying Hao
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Palo Alto, California
| | - X Bruce Ling
- Department of Surgery, Stanford University School of Medicine, Stanford, California
| | - Craig Sable
- Department of Pediatrics, Children's National Health System, Washington, District of Columbia
| | - Jiajia Luo
- Biomedical Engineering Department, Peking University, Beijing, China.
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Abstract
OBJECTIVES To investigate the prevalence of left ventricular systolic dysfunction (LVSD) in Malawian children with severe febrile illness and to explore associations between LVSD and mortality and lactate levels. DESIGN Prospective observational study. SETTING Pediatric ward of a tertiary government referral hospital in Malawi. PATIENTS Children between 60 days and 10 years old with severe febrile illness (fever with at least one sign of impaired perfusion plus altered mentation or respiratory distress) were enrolled at admission from October 2017 to February 2018. INTERVENTIONS Focused cardiac ultrasound (FoCUS) was performed, and serum lactate was measured for each child at enrollment, with repeat FoCUS the following day. LV systolic function was later categorized as normal, reduced, severely reduced, or hyperdynamic by two pediatric cardiologists blinded to clinical course and outcomes. MEASUREMENTS AND MAIN RESULTS Fifty-four children were enrolled. LVSD was present in 14 children (25.9%; 95% CI, 15.4-40.3%), of whom three had severely reduced function. Thirty patients (60%) had a lactate greater than 2.5 mmol/L, of which 20 (40%) were markedly elevated (>5 mmol/L). Ten children died during admission (18.5%). Of children who survived, 22.7% had decreased LV systolic function versus 40% of those who died. Dysfunction was not associated with mortality or elevated lactate. CONCLUSIONS Cardiac dysfunction may be present in one in four Malawian children with severe febrile illness, and mortality in these patients is especially high. Larger studies are needed to further clarify the role cardiac dysfunction plays in mortality and integrate practical bedside assessments for decision support around individualized resuscitation strategies.
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Hunter LD, Pecoraro AJK, Doubell AF, Monaghan MJ, Lloyd GW, Lombard CJ, Herbst PG. Screening for subclinical rheumatic heart disease: addressing borderline disease in a real-world setting. EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab041. [PMID: 35919886 PMCID: PMC9242066 DOI: 10.1093/ehjopen/oeab041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/21/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
Aims The World Heart Federation (WHF) criteria identify a large borderline rheumatic heart disease (RHD) category that has hampered the implementation of population-based screening. Inter-scallop separations (ISS) of the posterior mitral valve leaflet, a recently described normal variant of the mitral valve, appears to be an important cause of mild mitral regurgitation (MR) leading to misclassification of cases as WHF ‘borderline RHD’. This study aims to report the findings of the Echo in Africa project, a large-scale RHD screening project in South Africa and determine what proportion of borderline cases would be re-classified as normal if there were a systematic identification of ISS-related MR. Methods and results A prospective cross-sectional study of underserved secondary schools in the Western Cape was conducted. Participants underwent a screening study with a handheld (HH) ultrasound device. Children with an abnormal HH study were re-evaluated with a portable laptop echocardiography machine. A mechanistic evaluation was applied in cases with isolated WHF ‘pathological’ MR (WHF ‘borderline RHD’). A total of 5255 participants (mean age 15± years) were screened. A total of 3439 (65.8%) were female. Forty-nine cases of WHF ‘definite RHD’ [9.1 cases/1000 (95% confidence interval, CI, 6.8–12.1 cases/1000)] and 104 cases of WHF ‘borderline RHD’ [19.5 cases/1000 (95% CI, 16.0–23.7 cases/1000)] were identified. Inter-scallop separations-related MR was the underlying mechanism of MR in 48/68 cases classified as WHF ‘borderline RHD’ with isolated WHF ‘pathological’ MR (70.5%). Conclusion In a real-world, large-scale screening project, the adoption of a mechanistic evaluation based on the systematic identification of ISS-related MR markedly reduced the number of WHF ‘screen-positive’ cases misclassified as WHF ‘borderline RHD’. Implementing strategies that reduce this misclassification could reduce the cost- and labour burden on large-scale RHD screening programmes.
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Affiliation(s)
- Luke D Hunter
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa
| | - Alfonso J K Pecoraro
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa
| | - Anton F Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa
| | - Mark J Monaghan
- Department of Cardiology, King's College Hospital, Denmark Hill, London, SE5 9RS, United Kingdom
| | - Guy W Lloyd
- Echocardiography Laboratory, Barts Heart Centre, St Bartholomew’s Hospital,West Smithfield, London EC1A 7BE, United Kingdom
- Institute of Cardiovascular Sciences, University College London, 62 Huntley St,WC1E 6DD, London, United Kingdom
- William Harvey Research Institute Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, United Kingdom
| | - Carl J Lombard
- Division of Epidemiology and Biostatistics, Department of Global Health Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Drive, Tygerberg, Cape Town,7505, South Africa; and
| | - Philip G Herbst
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa
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Kazahura PT, Mushi TL, Pallangyo P, Janabi M, Kisenge R, Albaghdadi M, Majani N, Kija E. Prevalence and risk factors for Subclinical Rheumatic Heart Disease among primary school children in Dar es Salaam, Tanzania: a community based cross-sectional study. BMC Cardiovasc Disord 2021; 21:610. [PMID: 34930122 PMCID: PMC8686380 DOI: 10.1186/s12872-021-02377-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rheumatic heart disease (RHD) is the most common acquired heart disease occurring in children and adolescents. RHD is associated with significant morbidity and mortality particularly in low and middle- income countries (LMICs) where the burden is estimated to be higher compared to high income countries. Subclinical RHD is the presence of valvular lesion diagnosed by echocardiography in a person with no clinical manifestation of RHD. This study aimed at determining the prevalence, types and factors associated with subclinical RHD among primary school children in Dar Es Salaam, Tanzania. METHODS A descriptive community-based cross-sectional study was conducted in primary school children from February to May 2019. A standardized structured questionnaire was used to collect demographic characteristics, history of upper respiratory tract infections (URTIs), anthropometric measurements, and chest auscultation findings. Moreover echocardiographic screening was done to all children recruited into the study. World Heart Federation echocardiographic classification was used to define the types and prevalence of subclinical RHD. RESULTS A total of 949 primary school children were enrolled with females being predominant (57.1%). The prevalence of subclinical RHD was 34 per 1000. All the participants had mitral valve disease only whereby 17 had definite disease and 15 had a borderline disease. The associated factors for subclinical RHD were older age of more than 9 years (OR 10.8, 95% CI 1.4-82.2, P = 0.02) having three or more episodes of URTI in previous six months (OR 21, 95% CI 9.6-46, P = 0.00) and poor hygiene (OR 3, 95% CI 1.3-6.8, P = 0.009). CONCLUSION Subclinical RHD as detected by echocardiographic screening is prevalent in primary school children, uniformly affects the mitral valve, and is associated with potentially modifiable risk factors. Children with a history of more than three episodes of URTI in six months represents a high-risk population that should be targeted for RHD screening.
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Affiliation(s)
- Parvina Titus Kazahura
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania.
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania.
| | - Theophylly L Mushi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Pedro Pallangyo
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Rodrick Kisenge
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
| | - Mazen Albaghdadi
- Division of Cardiology and Section of Vascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Naizihijwa Majani
- Department of Paediatric Cardiology, Jakaya Kikwete Cardiac Institute, P.O Box 54141, Dar es Salaam, Tanzania
| | - Edward Kija
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, P.O Box 65001, Dar es Salaam, Tanzania
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11
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Okello E, Ndagire E, Muhamed B, Sarnacki R, Murali M, Pulle J, Atala J, Bowen AC, DiFazio MP, Nakitto MG, Harik NS, Kansiime R, Longenecker CT, Lwabi P, Agaba C, Norton SA, Omara IO, Oyella LM, Parks T, Rwebembera J, Spurney CF, Stein E, Tochen L, Watkins D, Zimmerman M, Carapetis JR, Sable CA, Beaton A. Incidence of acute rheumatic fever in northern and western Uganda: a prospective, population-based study. Lancet Glob Health 2021; 9:e1423-e1430. [PMID: 34419237 PMCID: PMC11144057 DOI: 10.1016/s2214-109x(21)00288-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Acute rheumatic fever is infrequently diagnosed in sub-Saharan African countries despite the high prevalence of rheumatic heart disease. We aimed to determine the incidence of acute rheumatic fever in northern and western Uganda. METHODS For our prospective epidemiological study, we established acute rheumatic fever clinics at two regional hospitals in the north (Lira district) and west (Mbarara district) of Uganda and instituted a comprehensive acute rheumatic fever health messaging campaign. Communities and health-care workers were encouraged to refer children aged 3-17 years, with suspected acute rheumatic fever, for a definitive diagnosis using the Jones Criteria. Children were referred if they presented with any of the following: (1) history of fever within the past 48 h in combination with any joint complaint, (2) suspicion of acute rheumatic carditis, or (3) suspicion of chorea. We excluded children with a confirmed alternative diagnosis. We estimated incidence rates among children aged 5-14 years and characterised clinical features of definite and possible acute rheumatic fever cases. FINDINGS Data were collected between Jan 17, 2018, and Dec 30, 2018, in Lira district and between June 5, 2019, and Feb 28, 2020, in Mbarara district. Of 1075 children referred for evaluation, 410 (38%) met the inclusion criteria; of these, 90 (22%) had definite acute rheumatic fever, 82 (20·0%) had possible acute rheumatic fever, and 24 (6%) had rheumatic heart disease without evidence of acute rheumatic fever. Additionally, 108 (26%) children had confirmed alternative diagnoses and 106 (26%) had an unknown alternative diagnosis. We estimated the incidence of definite acute rheumatic fever among children aged 5-14 years as 25 cases (95% CI 13·7-30·3) per 100 000 person-years in Lira district (north) and 13 cases (7·1-21·0) per 100 000 person-years in Mbarara district (west). INTERPRETATION To the best of our knowledge, this is the first population-based study to estimate the incidence of acute rheumatic fever in sub-Saharan Africa. Given the known rheumatic heart disease burden, it is likely that only a proportion of children with acute rheumatic fever were diagnosed. These data dispel the long-held hypothesis that the condition does not exist in sub-Saharan Africa and compel investment in improving prevention, recognition, and diagnosis of acute rheumatic fever. FUNDING American Heart Association Children's Strategically Focused Research Network Grant, THRiVE-2, General Electric, and Cincinnati Children's Heart Institute Research Core.
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Affiliation(s)
- Emmy Okello
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda; Department of Medicine, Makerere University, Kampala, Uganda
| | - Emma Ndagire
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Babu Muhamed
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Rachel Sarnacki
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Meghna Murali
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Jafesi Pulle
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Jenifer Atala
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Asha C Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, and Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia
| | - Marc P DiFazio
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - M G Nakitto
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Nada S Harik
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Rosemary Kansiime
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Chris T Longenecker
- Case Western Reserve University, Health Education Campus, Cleveland, OH, USA
| | - Peter Lwabi
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Collins Agaba
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Scott A Norton
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Isaac Otim Omara
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Linda Mary Oyella
- The Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Tom Parks
- Wellcome Center for Human Genetics, The London School of Tropical Medicine and Hygiene, London, UK
| | | | - Christopher F Spurney
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Elizabeth Stein
- University of Washington School of Medicine, Seattle, WA, USA
| | - Laura Tochen
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - David Watkins
- Department of Medicine and Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Jonathan R Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, and Department of Infectious Diseases, Perth Children's Hospital, Nedlands, WA, Australia
| | - Craig A Sable
- Makerere School of Health Sciences, Children's National Hospital, Washington DC, USA
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; The University of Cincinnati School of Medicine, Cincinnati, OH, USA.
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12
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Awareness of Rheumatic Heart Disease in Egypt: A National Multicenter Study. J Cardiovasc Dev Dis 2021; 8:jcdd8090108. [PMID: 34564126 PMCID: PMC8466231 DOI: 10.3390/jcdd8090108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/20/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
Background: While the prevalence of rheumatic heart disease (RHD) in Egypt is relatively high, data on the awareness of Egyptians about the cause of RHD are lacking. Methods: Using a pre-tested questionnaire, we performed a multicenter survey of outpatients attending 15 university hospitals across Egypt. Results: A total of 6958 participants were interviewed. Most subjects (81.7%) reported a previous experience of sore throat. Seeking treatment, most patients (69.3%) consulted a medical professional, while the others relied on self/peer medication. Individuals consulting a physician received antibiotics more frequently than those who did not (89.1 vs. 38.7%; OR: 12.4, 95% CI 10.8–14.1). The median RHD knowledge score in our sample was 4 (IQR = 6). While most subjects (56.3%) claimed knowledge of the complications of an untreated sore throat, only a third (34%) were aware of the association between sore throat and RHD. In a multivariate analysis, older age (Mean Difference [MD]: 1.58, 95% CI 1.37–1.79), female gender (MD: 0.89, 95% CI 0.75–1.04), higher education (MD: 1.10, 95% CI 0.90–1.30), and being interviewed outside Cairo (MD: 0.67, 95% CI 0.51–0.82) were significant predictors of knowledge about RHD. Conclusion: The current study showed low levels of awareness on the cause of RHD among Egyptians and highlights a pressing need for interventions to address this public knowledge gap.
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13
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Hunter LD, Doubell AF, Pecoraro AJK, Monaghan M, Lloyd G, Lombard CJ, Herbst PG. The variable spectrum of anterior mitral valve leaflet restriction in rheumatic heart disease screening. Echocardiography 2021; 38:729-736. [PMID: 33847025 DOI: 10.1111/echo.15039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/11/2021] [Accepted: 03/08/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION The World Heart Federation (WHF) screening criteria do not incorporate a strict, reproducible definition of anterior mitral valve leaflet (AMVL) restriction. Using a novel definition, we have identified two distinct AMVL restriction configurations. The first, called "distal tip" AMVL restriction is associated with additional morphological features of rheumatic heart disease (RHD), while the second, "gradual bowing" AMVL restriction is not. This "arch-like" leaflet configuration involves the base to tip of the medial MV in isolation. We hypothesize that this configuration is a normal variant. METHODOLOGY The prevalence and associated leaflet configurations of AMVL restriction were assessed in schoolchildren with an established "very low" (VLP), "high" (HP), and "very high" prevalence (VHP) of RHD. RESULTS 936 studies were evaluated (HP 577 cases; VLP 359 cases). Sixty-five cases of "gradual bowing" AMVL restriction were identified in the HP cohort (11.3%, 95% CI 8.9-14.1) and 35 cases (9.7%, 95% CI 7-13.2) in the VLP cohort (P = .47). In the second analyses, an enriched cohort of 43 studies with proven definite RHD were evaluated. "Distal tip" AMVL restriction was identified in all 43 VHP cases (100%) and affected the central portion of the AMVL in all cases. CONCLUSION "Gradual bowing" AMVL restriction appears to be a normal, benign variant of the MV, not associated with RHD risk nor with any other morphological features of RHD. Conversely, "Distal tip" AMVL restriction was present in all cases in the VHP cohort with no cases exhibiting a straight, nonrestricted central portion of the AMVL. This novel finding requires further investigation as a potential RHD rule-out test of the MV.
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Affiliation(s)
- Luke David Hunter
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Anton F Doubell
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa
| | - Alfonso J K Pecoraro
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa
| | | | - Guy Lloyd
- Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, London, UK.,Institute of Cardiovascular Sciences, UCL, London, UK.,William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Carl J Lombard
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town, South Africa.,Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Philip G Herbst
- Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Cape Town, South Africa
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14
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Hunter LD, Monaghan M, Lloyd G, Lombard C, Pecoraro AJK, Doubell AF, Herbst PG. Interscallop separations of the posterior mitral valve leaflet: a solution to the 'borderline RHD' conundrum? Open Heart 2020; 7:openhrt-2020-001452. [PMID: 33154146 PMCID: PMC7646362 DOI: 10.1136/openhrt-2020-001452] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 12/02/2022] Open
Abstract
Objective The World Heart Federation (WHF) criteria incorporate a Doppler-based system to differentiate between ‘physiological’ and ‘pathological’ mitral regurgitation (MR)—a sole criterion sufficient for the diagnosis of WHF ‘borderline’ rheumatic heart disease (RHD). We have identified that interscallop separations (ISS) of the posterior mitral valve (MV) leaflet, can give rise to pathological MR in an otherwise-normal MV. We aimed to establish and compare the prevalence of ISS-related MR among South African children at high and low risk for RHD. Methods A prospective cross-sectional echocardiographic study of 759 school children (aged 13–18) was performed. Cases with MR≥1.5 cm underwent a second comprehensive study to determine the prevalence of RHD according to the WHF guideline and establish the underlying mechanism of MR. Results Of 400 high-risk children, two met criteria for ‘definite RHD’ (5 per 1000 (95% CI 1.4 to 18.0); p=0.5) and 11 for ‘borderline RHD’ (27.5 per 1000 (95% CI 15.4 to 48.6)). Of 359 low-risk children, 14 met criteria for borderline RHD (39 per 1000 (95% CI 23.4 to 64.4)). Comprehensive echocardiography identified an underlying ISS as the mechanism of isolated pathological MR in 10 (83.3%) high-risk children and 11 low-risk children (78.5%; p>0.99). Conclusions ISS are a ubiquitous finding among South African schoolchildren from all risk profiles and are regularly identified as the underlying mechanism of WHF pathological MR in borderline RHD cases. A detailed MV assessment with an emphasis on ascertaining the underlying mechanism of dysfunction could reduce the reported numbers of screened cases misclassified as borderline RHD.
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Affiliation(s)
- Luke David Hunter
- Division of Cardiology, Department of Medicine, Tygerberg Academic Hospital, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Mark Monaghan
- Cardiology, King's College London School of Medical Education, London, United Kingdom
| | - Guy Lloyd
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Echocardiography Laboratory, Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.,Institute of Cardiovascular Sciences, University College London, London, United Kingdom.,William Harvey Research Institute, Queen Mary University of London, London, United Kingdom
| | - Carl Lombard
- Division of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town, Western Cape, South Africa
| | - Alfonso Jan Kemp Pecoraro
- Division of Cardiology, Department of Medicine, Tygerberg Academic Hospital, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Anton Frans Doubell
- Division of Cardiology, Department of Medicine, Tygerberg Academic Hospital, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Philipus George Herbst
- Division of Cardiology, Department of Medicine, Tygerberg Academic Hospital, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
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15
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Nkereuwem E, Ige OO, Yilgwan C, Jobe M, Erhart A, Bode-Thomas F. Prevalence of rheumatic heart disease in North-Central Nigeria: a school-based cross-sectional pilot study. Trop Med Int Health 2020; 25:1408-1415. [PMID: 32799403 DOI: 10.1111/tmi.13477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To present epidemiological data on rheumatic heart disease (RHD), the most common acquired heart disease in children and young adults in low- and middle-income countries, for North-Central Nigeria. METHODS In this pilot study, we conducted clinical and echocardiography screening on a cross section of randomly selected secondary schoolchildren in Jos, North-Central Nigeria, from March to September 2016. For outcome classification into borderline or definite RHD, we performed a confirmatory echocardiography using the World Heart Federation criteria for those suspected to have RHD from the screening. RESULTS A total of 417 secondary schoolchildren were screened, of whom 247 (59.2%) were female. The median age was 14 years (IQR: 13-15). Clinical screening detected 8/417 children, whereas screening echocardiography detected 42/417 suspected cases of RHD. Definitive echocardiography confirmed 9/417 with RHD corresponding to a prevalence of 21.6 per 1000 (95% CI, 6.7-36.5). All but one of the confirmed RHD cases (8/9) were borderline RHD corresponding to a prevalence of 19.2 per 1000 (95% CI, 8.3-37.5) for borderline RHD and 2.4 per 1000 (95% CI, 0.1-13.3) for definite RHD. RHD was more common in boys and cardiac auscultation missed over 50% of the cases. CONCLUSIONS This study showed a high prevalence of RHD among secondary schoolchildren in North-Central Nigeria with a vast predominance of asymptomatic borderline lesions. Larger school-based echocardiography screening using portable or handheld echocardiography aimed at early detection of subclinical RHD should be adopted.
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Affiliation(s)
- Esin Nkereuwem
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Olukemi O Ige
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria.,College of Health Sciences, University of Jos, Jos, Nigeria
| | - Christopher Yilgwan
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria.,College of Health Sciences, University of Jos, Jos, Nigeria
| | - Modou Jobe
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Annette Erhart
- Medical Research Council Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Fidelia Bode-Thomas
- Department of Paediatrics, Jos University Teaching Hospital, Jos, Nigeria.,College of Health Sciences, University of Jos, Jos, Nigeria
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16
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Peters F, Karthikeyan G, Abrams J, Muhwava L, Zühlke L. Rheumatic heart disease: current status of diagnosis and therapy. Cardiovasc Diagn Ther 2020; 10:305-315. [PMID: 32420113 DOI: 10.21037/cdt.2019.10.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Rheumatic heart disease (RHD) is the only preventable cardiovascular disease which causes significant morbidity and mortality particularly in low- and middle-income countries. Early clinical diagnosis is key, the updated Jones criteria increases the likelihood of diagnosis in endemic settings, including the echo diagnosis of sub-clinical carditis, polyarthralgia and monoarthritis as well as amended thresholds of minor criteria. The mainstay of rheumatic heart valve disease (RHVD) is a thorough clinical and echocardiographic investigation while severe disease is managed with medical, interventional and surgical treatment. In this report we detail some of the more recent epidemiological findings and focus on the diagnostic and interventional elements of the specific valve lesions. Finally, we discuss some of the recent efforts to improve medical and surgical management for this disease. As we are already more than a year from the historic 2018 World Heart Organization Resolution against Rheumatic Fever and Rheumatic Heart Disease, we advocate strongly for renewed efforts to prioritize this disease across the endemic regions of the world.
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Affiliation(s)
- Ferande Peters
- Cardiovascular pathophysiology and Genomic Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Ganesan Karthikeyan
- Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Jessica Abrams
- Division of Paediatric Cardiology, Department of Paediatrics, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Lorrein Muhwava
- Division of Paediatric Cardiology, Department of Paediatrics, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Liesl Zühlke
- Division of Paediatric Cardiology, Department of Paediatrics, Red Cross Children's Hospital, University of Cape Town, Cape Town, South Africa.,Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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17
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Machluf Y, Chaiter Y, Farkash R, Sebbag A, Fink DL. Rheumatic Fever in Large Cohort of Adolescents in Israel. Front Med (Lausanne) 2020; 6:328. [PMID: 32039216 PMCID: PMC6992586 DOI: 10.3389/fmed.2019.00328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 12/19/2019] [Indexed: 11/27/2022] Open
Abstract
Background: Acute rheumatic fever (ARF) remains a major worldwide healthcare problem, despite its progressive decline in developed countries. The aims of our study were to estimate the prevalence of ARF among adolescents in Israel and to investigate risk factors. Methods: The study population consisted of 113,671 consecutive conscripts 16–19 years old, born during 1971–1993, who completed the medical profiling as part of the recruitment process to the IDF. ARF was diagnosed according to Jones criteria at time of illness, with confirmation relying on medical documentation and cardiologist evaluation including echocardiography. Results: The general prevalence rate of ARF was 0.12%. A downward trend was observed, from 0.19% among those born during 1971–1980 to 0.07% among those born during 1981–1993. Differences in prevalence of ARF were noted in sub-populations based on country of birth and origin—Israel, Ethiopia and the former soviet union (FUSSR). The prevalence rates of valvar disease among ARF+ and ARF– recruits were 15.7% and 0.95%, respectively. In multivariable logistic regression analyses, 4 variables were negatively associated with ARF: later birth year group, female gender, rural residence, youngest child; and 3 were positively associated with ARF: young parents, above normal BMI and valvar disease. Conclusion: Our study provides support for the documented decline in ARF prevalence and describes socio-demographic and anthropometric risk factors including the association with valvar disease and novel risk factors including above normal BMI and young parents, both warranting further investigation which might help in developing societal level prevention strategies.
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Affiliation(s)
- Yossy Machluf
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel.,Shamir Research Institute, University of Haifa, Haifa, Israel
| | - Yoram Chaiter
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel
| | | | - Anat Sebbag
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel
| | - Daniel Lyon Fink
- Medical Corps, Israel Defense Forces (IDF), Haifa, Israel.,Shaare Zedek Medical Center, Jerusalem, Israel.,HaEmek Medical Center, Afula, Israel
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18
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Noubiap JJ, Agbor VN, Bigna JJ, Kaze AD, Nyaga UF, Mayosi BM. Prevalence and progression of rheumatic heart disease: a global systematic review and meta-analysis of population-based echocardiographic studies. Sci Rep 2019; 9:17022. [PMID: 31745178 PMCID: PMC6863880 DOI: 10.1038/s41598-019-53540-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 10/21/2019] [Indexed: 11/30/2022] Open
Abstract
This systematic review and meta-analysis aimed to provide a contemporaneous estimate of the global burden of rheumatic heart disease (RHD) from echocardiographic population-based studies. We searched multiple databases between January 01, 1996 and October 17, 2017. Random-effect meta-analysis was used to pool data. We included 82 studies (1,090,792 participant) reporting data on the prevalence of RHD and 9 studies on the evolution of RHD lesions. The pooled prevalence of RHD was 26.1‰ (95%CI 19.2–33.1) and 11.3‰ (95%CI 7.2–16.2) for studies which used the World Heart Federation (WHF) and World Health Organization (WHO) criteria, respectively. The prevalence of RHD varied inversely with the level of a country’s income, was lower with the WHO criteria compared to the WHF criteria, and was lowest in South East Asia. Definite RHD progressed in 7.5% (95% CI 1.5–17.6) of the cases, while 60.7% (95% CI 42.4–77.5) of cases remained stable over the course of follow-up. The proportion of cases borderline RHD who progressed to definite RHD was 11.3% (95% CI 6.9–16.5). The prevalence of RHD across WHO regions remains high. The highest prevalence of RHD was noted among studies which used the WHF diagnostic criteria. Definite RHD tends to progress or remain stable over time.
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Affiliation(s)
- Jean Jacques Noubiap
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Valirie N Agbor
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Jean Joel Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon. .,School of Public Health, Faculty of Medicine, University of Paris Sud XI, Le Kremlin-Bicêtre, France.
| | - Arnaud D Kaze
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA
| | - Ulrich Flore Nyaga
- Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Bongani M Mayosi
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.,The Dean's Office, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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19
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Beaton A, Okello E, Engelman D, Grobler A, Scheel A, DeWyer A, Sarnacki R, Omara IO, Rwebembera J, Sable C, Steer A. Determining the impact of Benzathine penicillin G prophylaxis in children with latent rheumatic heart disease (GOAL trial): Study protocol for a randomized controlled trial. Am Heart J 2019; 215:95-105. [PMID: 31301533 DOI: 10.1016/j.ahj.2019.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/01/2019] [Indexed: 11/15/2022]
Abstract
Rheumatic heart disease (RHD) remains a high prevalence condition in low- and middle-income countries. Most individuals with RHD present late, missing the opportunity to benefit from secondary antibiotic prophylaxis. Echocardiographic screening can detect latent RHD, but the impact of secondary prophylaxis in screen-detected individuals is not known. METHODS/DESIGN This trial aims to determine if secondary prophylaxis with every-4-week injectable Benzathine penicillin G (BPG) improves outcomes for children diagnosed with latent RHD. This is a randomized controlled trial in consenting children, aged 5 to 17 years in Northern Uganda, confirmed to have borderline RHD or mild definite RHD on echocardiography, according to the 2012 World Heart Federation criteria. Qualifying children will be randomized to every-4-week injectable intramuscular BPG or no medical intervention and followed for a period of 2 years. Ongoing intervention adherence and retention in the trial will be supported through the establishment of peer support groups for participants in the intervention and control arms. A blinded echocardiography adjudication panel consisting of four independent experts will determine the echocardiographic classification at enrollment and trajectory through consensus review. The primary outcome is the proportion of children in the BPG-arm who demonstrate echocardiographic progression of latent RHD compared to those in the control arm. The secondary outcome is the proportion of children in the BPG-arm who demonstrate echocardiographic regression of latent RHD compared to those in the control arm. A sample size of 916 participants will provide 90% power to detect a 50% relative risk reduction assuming a 15% progression in the control group. The planned study duration is from 2018-2021. DISCUSSION Policy decisions on the role of echocardiographic screening for RHD have stalled because of the lack of evidence of the benefit of secondary prophylaxis. The results of our study will immediately inform the standard of care for children diagnosed with latent RHD and will shape, over 2-3 years, practical and scalable programs that could substantially decrease the burden of RHD in our lifetime. TRIAL REGISTRATION ClinicalTrials.gov: NCT03346525. Date Registered: November 17, 2017.
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Affiliation(s)
- Andrea Beaton
- Cincinnati Children's Hospital Medical Center, The Heart Institute, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
| | | | - Daniel Engelman
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Anneke Grobler
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Amy Scheel
- Emory School of Medicine, Atlanta, GA, USA
| | - Alyssa DeWyer
- Children's National Medical Center, Washington, DC, USA
| | | | | | | | - Craig Sable
- Children's National Medical Center, Washington, DC, USA
| | - Andrew Steer
- Centre for International Child Health, Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia; Royal Children's Hospital, Melbourne, Victoria, Australia
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20
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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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21
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Ekure EN, Amadi C, Sokunbi O, Kalu N, Olusegun-Joseph A, Kushimo O, Hassan O, Ikebudu D, Onyia S, Onwudiwe C, Nwankwo V, Akinwunmi R, Awusa F, Akere Z, Dele-Salawu O, Ajayi E, Ale O, Muoneke D, Muenke M, Kruszka P, Beaton A, Sable C, Adeyemo A. Echocardiographic screening of 4107 Nigerian school children for rheumatic heart disease. Trop Med Int Health 2019; 24:757-765. [PMID: 30938017 DOI: 10.1111/tmi.13235] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Echocardiographic screening for Rheumatic Heart Disease (RHD) in Africa has revealed prevalence rates in the range of 0.5-7.4%. There are no recent large population-based studies in Nigeria. The objective of the study was to determine the prevalence of RHD in a large sample of Nigerian school children. METHODS Using portable transthoracic echocardiography and auscultation, school children aged 5 years to 16 years in Lagos, Nigeria were screened for RHD. Diagnosis was based on the 2012 World Heart Federation echocardiographic criteria. RESULTS The 4107 children screened had mean age of 11.3 years (SD = 2.6) and 2206 (53.7%) were females. There were 38 children with abnormal echocardiograms, of which 11 (0.27%) showed RHD including two cases of definite RHD giving a prevalence of 2.7/1000 [2.9/1000 in the peri-urban, 2.4/1000 in the urban area). Echocardiography detected RHD 10 times better than auscultation [echocardiography 11 (0.27%) vs. auscultation 1 (0.02%); P = 0.003]. The remaining 27 children with abnormal echocardiograms had congenital heart defects (CHD) giving a prevalence of 6.6/1000 for CHD, a yield higher than for RHD. CONCLUSION Prevalence of RHD among school children in Lagos, South West Nigeria is low compared to other African countries, possibly due to better access to medical care and antibiotic treatment for infections. Our data provides evidence that RHD prevalence may vary substantially within sub-Saharan Africa, necessitating targeted population-based sampling to better understand disease burden and distribution. Further work is needed to compare within- and between-country RHD prevalence as a basis for programme planning and control efforts.
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Affiliation(s)
- Ekanem N Ekure
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Casmir Amadi
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ogochukwu Sokunbi
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Nnenna Kalu
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Akinsanya Olusegun-Joseph
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Oyewole Kushimo
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olayinka Hassan
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Desmond Ikebudu
- Central Research Laboratory, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Sophia Onyia
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Chinonso Onwudiwe
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Victor Nwankwo
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Remi Akinwunmi
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Fukpode Awusa
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Zainab Akere
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olaolu Dele-Salawu
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Elizabeth Ajayi
- Department of Paediatrics, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Olagoke Ale
- Department of Medicine, College of Medicine, University of Lagos, Lagos, Nigeria.,Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Dorothy Muoneke
- Department of Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Maximillian Muenke
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Paul Kruszka
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Craig Sable
- Children's National Medical Center, Washington, DC, USA
| | - Adebowale Adeyemo
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
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22
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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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23
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Sanyahumbi A, Beaton A, Guffey D, Hosseinipour MC, Karlsten M, Minard CG, Penny DJ, Sable CA, Kazembe PN. Two-year evolution of latent rheumatic heart disease in Malawi. CONGENIT HEART DIS 2019; 14:614-618. [PMID: 30706669 DOI: 10.1111/chd.12756] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 01/03/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In asymptomatic children, screening echocardiography has been used to attempt to diagnose rheumatic heart disease (RHD) at an early stage (latent RHD). World Heart Federation guidelines have standardized categorization of "definite," "borderline," or no RHD by echo findings. The progression of RHD diagnosed through echo screening is not known. In 2014, we screened 1450 schoolchildren in Malawi. OBJECTIVE Our objective was to evaluate 2-year RHD evolution among those diagnosed through screening. METHODS Two-year follow-up echocardiograms of those diagnosed with latent RHD were read by a primary, secondary, then third reader if there was disagreement. Progression or regression of both definite and borderline groups were tabulated. Penicillin adherence, age, gender, number in home, and household income were compared between those with definite RHD who regressed to borderline and those that stayed definite. We utilized the local system used to track HIV defaulters in order to bring participants back into care. Comparisons were made using Fisher's exact and Wilcoxon rank-sum tests. RESULTS Of the 39 with borderline RHD, 1 was lost to follow-up (2.6%), 1 progressed to definite (2.6%), 19 remained borderline (48.7%), 17 (43.6%) regressed to normal, and 1 was reclassified as mitral valve prolapse (2.6%). Of the 11 with definite RHD, 6 (54.5%) remained definite, 4 regressed to borderline (36.4%), and 1 regressed to normal (9.1%). Two of 11 with definite RHD had penicillin adherence above 80% for the 2-year follow-up period. There were no differences in adherence, gender, age, household income, or number in household between those with definite RHD that regressed to borderline and those who did not (P > .19). CONCLUSIONS Borderlines had a very low progression rate to definite RHD. A strength of our study was a high retention rate (98%). Longer follow-up is needed to determine expected disease evolution.
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Affiliation(s)
- Amy Sanyahumbi
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Andrea Beaton
- Department of Pediatric Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Danielle Guffey
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Mina C Hosseinipour
- Department of Infectious Disease, University of North Carolina Project, University of North Carolina, Lilongwe, Malawi
| | - Melissa Karlsten
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Charles G Minard
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas
| | - Daniel J Penny
- Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Craig A Sable
- Department of Pediatric Cardiology, Children's National Heart Institute, Children's National Medical Center, Washington, District of Columbia
| | - Peter N Kazembe
- Department of Pediatrics, Baylor College of Medicine Clinical Center of Excellence, Lilongwe, Malawi
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24
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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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25
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Fink DL, Chaiter Y, Menahem S, Farkash R, Machluf Y. Valvular Heart Disease in a Young Israeli Ethiopian Immigrant Population From the Gondar Region With Implications for Rheumatic Heart Disease. Front Public Health 2018; 6:130. [PMID: 29868538 PMCID: PMC5960715 DOI: 10.3389/fpubh.2018.00130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/16/2018] [Indexed: 01/18/2023] Open
Abstract
Background Rheumatic heart disease (RHD) among Ethiopian school children was recently found to be 1.4%. Immigration of the Jewish population from the Gondar region to Israel created an opportunity for further enquiry. Methods A cross-sectional study of the cardiac status of 113,671 adolescent recruits aged 16-19 years from the northern district of Israel who completed the medical profiling process over a 22-year period. Results 140 recruits had a history of rheumatic fever (0.12%), although none from an Ethiopian origin (n = 1,719). The prevalence of valvular heart disease clinically and confirmed echocardiographically in Ethiopian recruits was not different from the total population (0.81 and 0.93%, respectively). However, the prevalence was higher in those migrating to Israel in their 13th year or older (2.09%), compared to those migrating at a younger age or born in Israel (0.49%). Conclusion The Ethiopian teenage Israeli population from Gondar had a high rate of auscultation positive and echocardiographically confirmed valvular disease that suggested a high rate of RHD (~1.6%), despite no relevant past history. Our findings also suggested that for the younger Ethiopian immigrants or Israeli born subjects of Ethiopian origin, the improved medical care may well reduce the prevalence of valvular heart disease to that of the rest of the local population.
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Affiliation(s)
- Daniel Lyon Fink
- Shaare Zedek Medical Center, Jerusalem, Israel.,Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | - Yoram Chaiter
- Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel
| | | | | | - Yossy Machluf
- Israel Defense Forces Medical Corps, Tel Hashomer, Ramat Gan, Israel.,Shamir Research Institute, University of Haifa, Kazerin, Israel
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26
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Davis K, Remenyi B, Draper ADK, Dos Santos J, Bayley N, Paratz E, Reeves B, Appelbe A, Cochrane A, Johnson TD, Korte LM, Do Rosario IM, Da Silva Almeida IT, Roberts KV, Carapetis JR, Francis JR. Rheumatic heart disease in Timor‐Leste school students: an echocardiography‐based prevalence study. Med J Aust 2018; 208:303-307. [DOI: 10.5694/mja17.00666] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/23/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Kimberly Davis
- Royal Darwin Hospital, Darwin, NT
- Hospital Nacional Guido Valadares, Dili, Timor‐Leste
| | | | - Anthony DK Draper
- Centre for Disease Control, Northern Territory Department of Health, Darwin, NT
| | | | | | | | | | - Alan Appelbe
- Geelong Cardiology Group, Barwon Health, Geelong, VIC
| | | | | | - Laura M Korte
- Paediatric WA Country Health Service – Kimberley, Broome, WA
| | | | | | | | | | - Joshua R Francis
- Royal Darwin Hospital, Darwin, NT
- Global and Tropical Health Division Menzies School of Health Research, Darwin, NT
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27
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Paratz ED, Bayley N. Heart disease in East Timor: cross-sectional analysis of 474 patients attending Timor-Leste's first cardiology service. Intern Med J 2017; 47:423-428. [PMID: 28145049 DOI: 10.1111/imj.13381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/09/2017] [Accepted: 01/23/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND East Timor is a developing country and is a close neighbour of Australia. The prevalence of cardiac disease is unknown. AIMS To describe the prevalence and patterns of cardiac disease in patients attending the first cardiology service of Timor-Leste. METHODS A cross-sectional retrospective analysis was performed of demographic and clinical data of 474 unique patients referred to outpatient cardiology clinics conducted in East Timor from 2003 to 2016. RESULTS Mean age was 29.9 ± 18.5 years, with females significantly younger than males (28.8 ± 16.9 vs 32.3 ± 20.6 years). Congenital cardiac disease patients were the youngest (15.5 ± 13.9 years) and cardiomyopathy patients the oldest (46.7 ± 17.8 years). Of patients with rheumatic heart disease, the majority had mitral stenosis (59.4%) and multi-valvular involvement (61.6%). Of note, 28.3% of patients with rheumatic heart disease presented with severe mitral stenosis. Amongst congenital heart disease patients, the most common diagnosis was atrial or ventricular septal defects (61% combined). A total of 19.2% of patients either required immediate referral for intervention or palliation for their cardiac disease. Patients referred to Australia for treatment were significantly younger (19.7 ± 11.7 years) than all other outcome groups. CONCLUSION Amongst young East Timorese, rheumatic heart disease and unrepaired congenital cardiac defects impose a significant burden. One-fifth of patients present to clinics with severe disease requiring urgent referral for surgery or palliation.
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Affiliation(s)
- Elizabeth D Paratz
- East Timor Hearts Fund, Melbourne, Victoria, Australia.,St Vincent's Health Melbourne, Melbourne, Victoria, Australia
| | - Noel Bayley
- East Timor Hearts Fund, Melbourne, Victoria, Australia
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28
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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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29
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Beaton A, Aliku T, Dewyer A, Jacobs M, Jiang J, Longenecker CT, Lubega S, McCarter R, Mirabel M, Mirembe G, Namuyonga J, Okello E, Scheel A, Tenywa E, Sable C, Lwabi P. Latent Rheumatic Heart Disease: Identifying the Children at Highest Risk of Unfavorable Outcome. Circulation 2017; 136:2233-2244. [PMID: 28972003 PMCID: PMC5716883 DOI: 10.1161/circulationaha.117.029936] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 09/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Screening echocardiography has emerged as a potentially powerful tool for early diagnosis of rheumatic heart disease (RHD). The utility of screening echocardiography hinges on the rate of RHD progression and the ability of penicillin prophylaxis to improve outcome. We report the longitudinal outcomes of a cohort of children with latent RHD and identify risk factors for unfavorable outcomes. METHODS This was a prospective natural history study conducted under the Ugandan RHD registry. Children with latent RHD and ≥1 year of follow-up were included. All echocardiograms were re-reviewed by experts (2012 World Heart Federation criteria) for inclusion and evidence of change. Bi- and multivariable logistic regression, Kaplan-Meier analysis, and Cox proportional hazards models, as well, were developed to search for risk factors for unfavorable outcome and compare progression-free survival between those treated and not treated with penicillin. Propensity and other matching methods with sensitivity analysis were implemented for the evaluation of the penicillin effect. RESULTS Blinded review confirmed 227 cases of latent RHD: 164 borderline and 63 definite (42 mild, 21 moderate/severe). Median age at diagnosis was 12 years and median follow-up was 2.3 years (interquartile range, 2.0-2.9). Penicillin prophylaxis was prescribed in 49.3% with overall adherence of 84.7%. Of children with moderate-to-severe definite RHD, 47.6% had echocardiographic progression (including 2 deaths), and 9.5% had echocardiographic regression. Children with mild definite and borderline RHD showed 26% and 9.8% echocardiographic progression and 45.2% and 46.3% echocardiographic improvement, respectively. Of those with mild definite RHD or borderline RHD, more advanced disease category, younger age, and morphological mitral valve features were risk factors for an unfavorable outcome. CONCLUSIONS Latent RHD is a heterogeneous diagnosis with variable disease outcomes. Children with moderate to severe latent RHD have poor outcomes. Children with both borderline and mild definite RHD are at substantial risk of progression. Although long-term outcome remains unclear, the initial change in latent RHD may be evident during the first 1 to 2 years following diagnosis. Natural history data are inherently limited, and a randomized clinical trial is needed to definitively determine the impact of penicillin prophylaxis on the trajectory of latent RHD.
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Affiliation(s)
- Andrea Beaton
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.).
| | - Twalib Aliku
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Alyssa Dewyer
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Marni Jacobs
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Jiji Jiang
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Chris T Longenecker
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Sulaiman Lubega
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Robert McCarter
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Mariana Mirabel
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Grace Mirembe
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Judith Namuyonga
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Emmy Okello
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Amy Scheel
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Emmanuel Tenywa
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Craig Sable
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
| | - Peter Lwabi
- Children's National Health System, Washington DC (A.B., A.D., M.J., J.J., R.M., A.S., C.S.). Gulu University, Uganda (T.A.). Case Western Reserve University, Cleveland, OH (C.T.L.). Uganda Heart Institute, Kampala (S.L., J.N., E.O., E.T., P.L.). INSERM U970 (French National Institute of Health and Medical Research), Paris-Cardiovascular Research Center PARCC, France (M.M.). Joint Clinical Research Centers, Kampala, Uganda (G.M.)
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Saxena A, Desai A, Narvencar K, Ramakrishnan S, Thangjam RS, Kulkarni S, Jacques' E Costa AK, Mani K, Dias A, Sukharamwala R. Echocardiographic prevalence of rheumatic heart disease in Indian school children using World Heart Federation criteria - A multi site extension of RHEUMATIC study (the e-RHEUMATIC study). Int J Cardiol 2017; 249:438-442. [PMID: 28966041 DOI: 10.1016/j.ijcard.2017.09.184] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 08/18/2017] [Accepted: 09/20/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Rheumatic heart disease (RHD) continues to be major public health burden in developing world. Echocardiographic screening in school children has shown that subclinical RHD cases are several times more than clinical cases. Recent reports have used World Heart Federation (WHF) criteria. Objective of present study was to determine RHD prevalence using WHF criteria in Indian children. METHODS Children (5-15years) from randomly selected schools across four sites were included. After focused clinical evaluation, echocardiography was performed using WHF criteria in all children. Images/loops of abnormal cases were analyzed independently by an additional experienced cardiologist. Children with murmur and confirmatory echocardiography were categorized 'clinical RHD'; those with abnormal echocardiography alone were labeled 'subclinical RHD'. RESULTS Among 16,294 children included, mean age was 10.8 ± 2.9years; 55.1% were males; 11,405 (70%) were from rural areas and 3978 (24.4%) were from government schools. We detected RHD by echocardiography in 125 children [prevalence: 7.7/1000 (95% CI 6.3, 9.0)]. Borderline RHD was present in 93 children (5.7/1000, 95% CI 4.6, 6.9), definite RHD in 32 (2/1000, 95% CI 1.2, 2.6), and clinical RHD in six [0.36/1000, 95% CI: 0.1-0.7]. On univariate analysis, older age, female gender, and higher waist circumference were associated while on multivariate analysis, older age (OR 1.18, 95% CI: 1.09, 1.26) and female gender (OR 1.61, 95% CI: 1.13, 2.3) were associated with RHD. CONCLUSION RHD prevalence varies in different parts of India. Echocardiographic prevalence is several times higher than clinical and underscores importance of echocardiographic screening in community.
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Affiliation(s)
- Anita Saxena
- Department of Cardiology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
| | - Ankush Desai
- Department of Medicine, Goa Medical College, Bambolim, Goa, India
| | | | | | - Rajendra Singh Thangjam
- Department of Medicine, Jawaharlal Nehru Institute of Medical Sciences, Imphal, Manipur, India
| | | | | | - Kalaivani Mani
- Department of Biostatistics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - Amit Dias
- Department of Preventive & Social Medicine, Goa Medical College, Bambolim, Goa, India
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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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32
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Task shifting to clinical officer-led echocardiography screening for detecting rheumatic heart disease in Malawi, Africa. Cardiol Young 2017; 27:1133-1139. [PMID: 27989261 DOI: 10.1017/s1047951116002511] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Echocardiographic screening for rheumatic heart disease in asymptomatic children may result in early diagnosis and prevent progression. Physician-led screening is not feasible in Malawi. Task shifting to mid-level providers such as clinical officers may enable more widespread screening. Hypothesis With short-course training, clinical officers can accurately screen for rheumatic heart disease using focussed echocardiography. METHODS A total of eight clinical officers completed three half-days of didactics and 2 days of hands-on echocardiography training. Clinical officers were evaluated by performing screening echocardiograms on 20 children with known rheumatic heart disease status. They indicated whether children should be referred for follow-up. Referral was indicated if mitral regurgitation measured more than 1.5 cm or there was any measurable aortic regurgitation. The κ statistic was calculated to measure referral agreement with a paediatric cardiologist. Sensitivity and specificity were estimated using a generalised linear mixed model, and were calculated on the basis of World Heart Federation diagnostic criteria. RESULTS The mean κ statistic comparing clinical officer referrals with the paediatric cardiologist was 0.72 (95% confidence interval: 0.62, 0.82). The κ value ranged from a minimum of 0.57 to a maximum of 0.90. For rheumatic heart disease diagnosis, sensitivity was 0.91 (95% confidence interval: 0.86, 0.95) and specificity was 0.65 (95% confidence interval: 0.57, 0.72). CONCLUSION There was substantial agreement between clinical officers and paediatric cardiologists on whether to refer. Clinical officers had a high sensitivity in detecting rheumatic heart disease. With short-course training, clinical officer-led echo screening for rheumatic heart disease is a viable alternative to physician-led screening in resource-limited settings.
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Keates AK, Mocumbi AO, Ntsekhe M, Sliwa K, Stewart S. Cardiovascular disease in Africa: epidemiological profile and challenges. Nat Rev Cardiol 2017; 14:273-293. [PMID: 28230175 DOI: 10.1038/nrcardio.2017.19] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
From a global perspective, the large and diverse African population is disproportionately affected by cardiovascular disease (CVD). The historical balance between communicable and noncommunicable pathways to CVD in different African regions is dependent on external factors over the life course and at a societal level. The future risk of noncommunicable forms of CVD (predominantly driven by increased rates of hypertension, smoking, and obesity) is a growing public health concern. The incidence of previously rare forms of CVD such as coronary artery disease will increase, in concert with historically prevalent forms of disease, such as rheumatic heart disease, that are yet to be optimally prevented or treated. The success of any strategies designed to reduce the evolving and increasing burden of CVD across the heterogeneous communities living on the African continent will be dependent upon accurate and up-to-date epidemiological data on the cardiovascular profile of every major populace and region. In this Review, we provide a contemporary picture of the epidemiology of CVD in Africa, highlight key regional discrepancies among populations, and emphasize what is currently known and, more importantly, what is still unknown about the CVD burden among the >1 billion people living on the continent.
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Affiliation(s)
- Ashley K Keates
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
| | - Ana O Mocumbi
- Instituto Nacional de Saúde, Ministério da Saúde, Av. Eduardo Mondlane/Salvador Allende Caixa Postal 264, Maputo, Moçambique
| | - Mpiko Ntsekhe
- Division of Cardiology, Department of Medicine, University of Cape Town, Old Main Building, Groote Schuur Hospital, Observatory, Cape Town 7925, South Africa
| | - Karen Sliwa
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Centre, 4th floor Chris Barnard Building, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
| | - Simon Stewart
- Mary MacKillop Institute for Health Research, Australian Catholic University, Level 5, 215 Spring Street, Melbourne, Victoria 3000, Australia
- Hatter Institute for Cardiovascular Research in Africa, Cape Heart Centre, 4th floor Chris Barnard Building, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa
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Gemechu T, Mahmoud H, Parry EHO, Phillips DIW, Yacoub MH. Community-based prevalence study of rheumatic heart disease in rural Ethiopia. Eur J Prev Cardiol 2017; 24:717-723. [DOI: 10.1177/2047487316687104] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | | | | | - Magdi H Yacoub
- Aswan Heart Centre, Aswan, Egypt
- NHLI, Heart Science Centre, Imperial College London, UK
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