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Are minor echocardiographic changes associated with an increased risk of acute rheumatic fever or progression to rheumatic heart disease?

Remond, Marc, Atkinson, David, White, Andrew, Brown, Alex, Carapetis, Jonathan R., Remenyi, Bo, Roberts, Kathryn L. and Maguire, Graeme P. (2015). Are minor echocardiographic changes associated with an increased risk of acute rheumatic fever or progression to rheumatic heart disease?. International Journal of Cardiology,198:117-122.

Document type: Journal Article
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IRMA ID 81144320xPUB71
Title Are minor echocardiographic changes associated with an increased risk of acute rheumatic fever or progression to rheumatic heart disease?
Author Remond, Marc
Atkinson, David
White, Andrew
Brown, Alex
Carapetis, Jonathan R.
Remenyi, Bo
Roberts, Kathryn L.
Maguire, Graeme P.
Journal Name International Journal of Cardiology
Publication Date 2015
Volume Number 198
ISSN 0167-5273   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84940373224
Start Page 117
End Page 122
Total Pages 6
Place of Publication Ireland
Publisher Elsevier Ireland Ltd.
Field of Research MEDICAL AND HEALTH SCIENCES
HERDC Category C1 - Journal Article (DIISR)
Abstract Background
The World Heart Federation criteria for the echocardiographic diagnosis of rheumatic heart disease (RHD) include a category “Borderline” RHD which may represent the earliest evidence of RHD. We aimed to determine the significance of minor heart valve abnormalities, including Borderline RHD, in predicting the future risk of acute rheumatic fever (ARF) or RHD.

Methods

A prospective cohort study of Aboriginal and Torres Strait Islander children aged 8 to 18 years was conducted. Cases comprised children with Borderline RHD or other minor non-specific valvular abnormalities (NSVAs) detected on prior echocardiography. Controls were children with a prior normal echocardiogram. Participants underwent a follow-up echocardiogram 2.5 to 5 years later to assess for progression of valvular changes and development of Definite RHD. Interval diagnoses of ARF were ascertained.

Results

There were 442 participants. Cases with Borderline RHD were at significantly greater risk of ARF (incidence rate ratio 8.8, 95% CI 1.4–53.8) and any echocardiographic progression of valve lesions (relative risk 8.19, 95% CI 2.43–27.53) than their Matched Controls. Cases with Borderline RHD were at increased risk of progression to Definite RHD (1 in 6 progressed) as were Cases with NSVAs (1 in 10 progressed).

Conclusions

Children with Borderline RHD had an increased risk of ARF, progression of valvular lesions, and development of Definite RHD. These findings provide support for considering secondary antibiotic prophylaxis or ongoing surveillance echocardiography in high-risk children with Borderline RHD.
Keywords Rheumatic heart disease
Echocardiography
Screening
Diagnosis
Acute rheumatic fever
DOI http://dx.doi.org/10.1016/j.ijcard.2015.07.005   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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