Echocardiographic Screening for Rheumatic Heart Disease in High and Low Risk Australian Children
Background—Echocardiographic screening for rheumatic heart disease (RHD) is becoming more widespread, but screening studies to date have used different echocardiographic definitions. The World Heart Federation (WHF) has recently published new criteria for the echocardiographic diagnosis of RHD. We aimed to establish the prevalence of RHD in high-risk Indigenous Australian children using these criteria, and to compare the findings with a group of Australian children at low risk for RHD.
Methods and Results—Portable echocardiography was performed on high-risk Indigenous children aged 5 to15 years living in remote communities of northern Australia. A comparison group of low-risk, non-Indigenous children living in urban centers was also screened. Echocardiograms were reported in a standardized, blinded fashion. Of 3946 high-risk children, 34 met WHF criteria for Definite RHD (prevalence 8.6 per 1000; 95% CI 6.0-12.0) and 66 for Borderline RHD (prevalence 16.7 per 1000; 95% CI 13.0-21.2). Of 1053 low-risk children, none met criteria for Definite RHD, and 5 met criteria for Borderline RHD. High-risk children were more likely to have Definite or Borderline RHD than low-risk children (adjusted odds ratio 5.7, 95% CI 2.3-14.1, p<0.001).
Conclusions—The prevalence of Definite RHD in high-risk Indigenous Australian children approximates what we expected in our population, and no Definite RHD was identified in low risk children. This study suggests that Definite RHD, as defined by the WHF criteria, is likely to represent true disease. Borderline RHD was identified in both low- and high-risk children, highlighting the need for longitudinal studies to evaluate the clinical significance of this finding.
- Received August 25, 2013.
- Revision received February 2, 2014.
- Accepted February 7, 2014.