Echocardiography screening to detect rheumatic heart disease: A cohort study of schoolchildren in French Pacific Islands

Abstract

Objective: The objective of this study is to assess the outcomes of rheumatic heart disease (RHD) diagnosed by means of echocardiography-based screening.

Methods: A cohort of children with and with no RHD was driven from a systematic echocardiography-based nationwide surveillance among 4th grade (age 9-10 years) schoolchildren in South-Pacific New Caledonia (2008-2011). The specific follow-up programme used clinical and standardised echocardiography (2012 World Heart Federation criteria) predefined endpoints.

Results: Out of the 17,633 children screened, 157 were detected with findings of RHD. Among them, 114 consented children (76.5%) were enrolled (RHD-group), and were compared to 227 randomly selected healthy classmates (non-RHD group). After a median follow-up period of 2.58 years [1.31-3.63], incidence of acute rheumatic fever was similar in RHD and non-RHD groups (p=0.23): 10.28/1000/year and 3.31/1000/year, respectively. By echocardiography, 90 children in the RHD group (78.9%) still presented with RHD at follow-up, compared to 31 (13.7%) in the non-RHD group (p<0.0001). Only 12 children (10.5%) experienced progression of RHD over time, mild single valve disease lesions remaining unchanged in the majority of cases (61 out of 73, 83.6%). Overcrowded living conditions were independently associated with persistent RHD on echocardiography (OR 8.27 95% CI (1.67-41.08), p<0.01). Benzathine penicillin G was given in 88.6% of children in the RHD-group.

Conclusions: Children screened positive for RHD by echocardiography have mostly mild but irreversible heart valve disease under secondary prophylaxis. Our findings also suggest that a single screening point in childhood may prove insufficient in high-risk populations.

Keywords: Acute rheumatic fever; Global health; Heart valve disease; Rheumatic heart disease; Ultrasounds.