Abstract 13145: Latent Rheumatic Heart Disease: Outcomes Two Years After Echocardiographic Detection
Background: Screening with portable echocardiography (echo) has uncovered a large burden of latent rheumatic heart disease (RHD) among asymptomatic children in endemic regions. Detection of latent RHD allows early intervention with secondary prophylaxis, potentially reducing the global burden of advanced disease. The significance of latent RHD, however, remains unclear. This study presents two years of longitudinal data on the clinical and echo status of 51 Ugandan children with latent RHD diagnosed by echo. It also reports the risk-factor profile of those with disease persistence or progression.
Methods: In 2010, almost 5000 asymptomatic children underwent school-based echo screening. Children identified with latent RHD enrolled in a biannual follow-up program. They received clinical and echo evaluation, plus information designed to improve disease recognition and treatment. New and original echos were interpreted according to the 2012 World Heart Federation guidelines. Risk factors for disease persistence and progression were examined.
Results: 51 of 62 children (82%) with latent RHD had a median follow-up of 25 months (mean 20.8 months; range 7-25 months). 17 of 51 children (33.3%), compared to zero at initial evaluation, reported interval sore throat or symptoms consistent with acute rheumatic fever (ARF). Of 43 children initially classified as 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 definite RHD, 6 (75%) remained stable, and 2 (25%) improved to borderline RHD. Two children had confirmed episodes of recurrent ARF; one of these representing the sole case of clinical worsening. Risk factors for disease persistence or progression included younger age (p=0.05) and higher ASO titers at diagnosis (p=0.05), and more morphologic valve abnormalities (p=0.01).
Conclusions: After 2 years, most children had a benign course: 91% remained stable or improved. Education may improve recognition of streptococcal sore throat. Longer term follow-up, however, is warranted to confirm disease progression and risk-factor profile. This could help tailor screening protocols to those at highest risk.
- © 2013 by American Heart Association, Inc.