Abstract 16421: Follow-Up of Subclinical Rheumatic Heart Disease in Children
Introduction: The concept of "subclinical" RHD emerged from echocardiography screening for Rheumatic Heart Disease (RHD). However, the pathogenicity and prognostic value of this new entity are still debated among experts. Follow-up data of children with subclinical lesions are most needed before implementing large scale screening programs in endemic regions. We aim at assessing the prognosis of mild valve lesions through RHD screening in New Caledonia.
Methods and Results: A follow-up study involving 17,633 school-children screened for RHD was performed from 2008 to 2013. Overall, 149 children aged 9-10 years were diagnosed with subclinical RHD by experienced cardiologists. Among 17,484 children with no RHD lesions, 428 children were randomly sampled for follow-up. Children suspected of having RHD were offered secondary prophylaxis. Among the 577 potential participants, data of 341 children (114 RHD + 227 non RHD) with standardized echocardiography (2012 World Heart Federation criteria for RHD diagnosis and experienced blinded reader) were analysed. Median follow-up was 2.5 years (IQR 0.5-4.6). Among the initial RHD cases, 89 (78.1%) had Definite (40 cases, 35.1%) or Borderline RHD (49 cases, 43.0%) at follow-up, while 25 (21.9%) reverted to normal. Out of 114 initial RHD children, 3 (2.6%) presented with Acute Rheumatic Fever (ARF) during follow-up. Among 227 initial non-RHD children, 32 (14.1%) presented with abnormal follow-up echocardiograms (3 (1.3%) Definite RHD; 29 (12.8%) Borderline RHD). Three (1.3%) presented with ARF during follow-up. Children with initial abnormal echocardiogram at age 9-10 years were most likely to fulfill a standardized diagnosis of subclinical RHD at follow-up [RR 5.6, CI 95% (4.0-7.9)].
Conclusion: Children in our cohort presented progression of disease similar to children with acute rheumatic fever and carditis under secondary prophylaxis, suggesting a genuine pathogenicity for subclinical RHD. On the other hand, a significant proportion of non-RHD individuals developed either signs of clinical or subclinical RHD at follow-up. This finding is in line with the peak incidence of disease observed later during adolescence and supports the need for repeated screening in the young.
- © 2013 by American Heart Association, Inc.