Pediatric Cardiology

, Volume 35, Issue 7, pp 1259–1267

Latent Rheumatic Heart Disease: Outcomes 2 Years After Echocardiographic Detection

  • Andrea Beaton
  • Emmy Okello
  • Twalib Aliku
  • Sulaiman Lubega
  • Peter Lwabi
  • Charles Mondo
  • Robert McCarter
  • Craig Sable
Original Article

Abstract

Screening with portable echocardiography has uncovered a large burden of latent rheumatic heart disease (RHD) among asymptomatic children in endemic regions, the significance of which remains unclear. This study aimed to determine the 2-year outcomes for children with latent RHD diagnosed by echocardiographic screening. Children identified with latent RHD enrolled in a biannual follow-up program. Risk factors for disease persistence and progression were examined. Of 62 children, 51 (82 %) with latent RHD had a median follow-up period of 25 months. Of these 51 children, 17 (33.3 %) reported an interval sore throat or symptoms consistent with acute rheumatic fever (ARF). Of 43 children initially classified as having borderline RHD, 21 (49 %) remained stable, 18 (42 %) improved (to no RHD) and 4 (10 %) worsened to definite RHD. Of the 8 children initially classified as having definite RHD, 6 (75 %) remained stable, and 2 (25 %) improved to borderline RHD. Two children had confirmed episodes of recurrent ARF, one of which represented the sole case of clinical worsening. The risk factors for disease persistence or progression included younger age (p = 0.05), higher antistreptolysin O titers at diagnosis (p = 0.05), and more morphologic valve abnormalities (p = 0.01). After 2 years, most of the children had a benign course, with 91 % remaining stable or showing improvement. Education may improve recognition of streptococcal sore throat. Longer-term follow-up evaluation, however, is warranted to confirm disease progression and risk factor profile. This could help tailor screening protocols for those at highest risk.

Keywords

Rheumatic heart disease Acute rheumatic fever Follow-up Echocardiography 

References

  1. 1.
    Beaton A, Okello E, Lwabi P, Mondo C, McCarter R, Sable C (2012) Echocardiography screening for rheumatic heart disease in Ugandan schoolchildren. Circulation 125:3127–3132CrossRefPubMedGoogle Scholar
  2. 2.
    Bhaya M, Panwar S, Beniwal R, Panwar RB (2010) High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography 27:448–453CrossRefPubMedGoogle Scholar
  3. 3.
    Bhaya M, Beniwal R, Panwar S, Panwar RB (2011) Two years of follow-up validates the echocardiographic criteria for the diagnosis and screening of rheumatic heart disease in asymptomatic populations. Echocardiography 28:929–933CrossRefPubMedGoogle Scholar
  4. 4.
    Bland EF, Duckett Jones T (1951) Rheumatic fever and rheumatic heart disease; a twenty-year report on 1,000 patients followed since childhood. Circulation 4:836–843CrossRefPubMedGoogle Scholar
  5. 5.
    Carapetis JR, Hardy M, Fakakovikaetau T, Taib R, Wilkinson L, Penny DJ, Steer AC (2008) Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren. Nat Clin Pract Cardiovasc Med 5:411–417CrossRefPubMedGoogle Scholar
  6. 6.
    Feinstein AR, Spagnuolo M, Wood HF, Taranta A, Tursky E, Kleinberg E (1964) Rheumatic fever in children and adolescents: a long-term epidemiologic study of subsequent prophylaxis, streptococcal infections, and clinical sequelae: VI. Clinical features of streptococcal infections and rheumatic recurrences. Ann Intern Med 60(Suppl 5):68–86CrossRefPubMedGoogle Scholar
  7. 7.
    Majeed HA, Yousof AM, Khuffash FA, Yusuf AR, Farwana S, Khan N (1986) The natural history of acute rheumatic fever in Kuwait: a prospective six year follow-up report. J Chron Dis 39(5):361–369CrossRefPubMedGoogle Scholar
  8. 8.
    Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, Paquet C, Jacob S, Sidi D, Jouven X (2007) Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 357:470–476CrossRefPubMedGoogle Scholar
  9. 9.
    Meira ZM, Goulart EM, Colosimo EA, Mota CC (2005) Long-term follow-up of rheumatic fever and predictors of severe rheumatic valvar disease in Brazilian children and adolescents. Heart 91:1019–1022PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Mirabel M, Celermajer DS, Ferreira B, Tafflet M, Perier MC, Karam N, Mocumbi AO, Jani DN, Sidi D, Jouven X, Marijon E (2012) Screening for rheumatic heart disease: evaluation of a simplified echocardiography-based approach. Eur Heart J Cardiovasc Imaging 13:1024–1029CrossRefPubMedGoogle Scholar
  11. 11.
    Paar JA, Berrios NM, Rose JD, Caceres M, Pena R, Perez W, Chen-Mok M, Jolles E, Dale JB (2010) Prevalence of rheumatic heart disease in children and young adults in Nicaragua. Am J Cardiol 105:1809–1814PubMedCentralCrossRefPubMedGoogle Scholar
  12. 12.
    Pelajo CF, Lopez-Benitez JM, Torres JM, de Oliveira SK (2010) Adherence to secondary prophylaxis and disease recurrence in 536 Brazilian children with rheumatic fever. Pediatr Rheum Online J 8:22CrossRefGoogle Scholar
  13. 13.
    Remenyi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, Lawrenson J, Maguire G, Marijon E, Mirabel M, Mocumbi AO, Mota C, Paar J, Saxena A, Scheel J, Stirling J, Viali S, Balekundri VI, Wheaton G, Zuhlke L, Carapetis J (2012) World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease-an evidence-based guideline. Nat Rev Cardiol 9:297–309CrossRefPubMedGoogle Scholar
  14. 14.
    Remenyi B, Carapetis J, Wyber R, Taubert K, Mayosi BM (2013) Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease. Nat Rev Cardiol 10:284–292CrossRefPubMedGoogle Scholar
  15. 15.
    Roberts K, Colquhoun S, Steer A, Remenyi B, Carapetis J (2012) Screening for rheumatic heart disease: current approaches and controversies. Nat Rev Cardiol 10(1):49–58CrossRefPubMedGoogle Scholar
  16. 16.
    Saxena A, Ramakrishnan S, Roy A, Seth S, Krishnan A, Misra P, Kalaivani M, Bhargava B, Flather MD, Poole-Wilson PP (2011) Prevalence and outcome of subclinical rheumatic heart disease in India: the RHEUMATIC [Rheumatic Heart Echo Utilisation and Monitoring Actuarial Trends in Indian Children] study. Heart 97:2018–2022CrossRefPubMedGoogle Scholar
  17. 17.
    Tubridy-Clark M, Carapetis JR (2007) Subclinical carditis in rheumatic fever: a systematic review. Int J Cardiol 119:54–58CrossRefPubMedGoogle Scholar
  18. 18.
    Webb RH, Wilson NJ, Lennon DR, Wilson EM, Nicholson RW, Gentles TL, O’Donnell CP, Stirling JW, Zeng I, Trenholme AA (2011) Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic. Cardiol Young 21:436–443CrossRefPubMedGoogle Scholar
  19. 19.
    Yavuz T, Nisli K, Oner N, Dindar A, Aydogan U, Omeroglu RE, Ertugrul T (2008) Long-term follow-up results of 139 Turkish children and adolescents with rheumatic heart disease. Eur J Pediatr 167:1321–1326CrossRefPubMedGoogle Scholar
  20. 20.
    Yilmazer MM, Oner T, Tavli V, Cilengiroglu OV, Guven B, Mese T, Vitrinel A, Devrim I (2012) Predictors of chronic valvular disease in patients with rheumatic carditis. Pediatr Cardiol 33:239–244CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Andrea Beaton
    • 1
  • Emmy Okello
    • 2
  • Twalib Aliku
    • 2
  • Sulaiman Lubega
    • 2
  • Peter Lwabi
    • 2
  • Charles Mondo
    • 3
  • Robert McCarter
    • 1
  • Craig Sable
    • 1
  1. 1.Children’s National Medical CenterWashingtonUSA
  2. 2.Uganda Heart InstituteKampalaUganda
  3. 3.Mulago HospitalKampalaUganda

Personalised recommendations