The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study

Liesl Zühlke^{1

2}, Mark E Engel³, Carolina E Lemmer⁴, Marnie van de Wall⁵, Simpiwe Nkepu⁶, Alet Meiring^{7

8}, Michael Bestawros^{9

10}, Bongani M Mayosi¹¹

Affiliations

¹ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. liesl.zuhlke@uct.ac.za.
² Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. liesl.zuhlke@uct.ac.za.
³ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. mark.engel@uct.ac.za.
⁴ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. caroliseclintech@yahoo.com.
⁵ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. marnie.vandewall@uct.ac.za.
⁶ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. Simpiwe.nkepu@uct.ac.za.
⁷ Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. aletmeiring@gmail.com.
⁸ Present address: Division of Cardiology, Department of Internal Medicine, Tygerberg Hospital and Stellenbosch University, Parow, South Africa. aletmeiring@gmail.com.
⁹ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. mbestaw@gmail.com.
¹⁰ Present address: New Mexico Heart Institute and the University of New Mexico, Albuquerque, NM, USA. mbestaw@gmail.com.
¹¹ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. bongani.mayosi@uct.ac.za.

PMID: 26892774
PMCID: PMC4759741
DOI: 10.1186/s12872-016-0225-3

Observational Study

The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study

Liesl Zühlke et al. BMC Cardiovasc Disord. 2016.

. 2016 Feb 19:16:46.

doi: 10.1186/s12872-016-0225-3.

Authors

Liesl Zühlke^{1

2}, Mark E Engel³, Carolina E Lemmer⁴, Marnie van de Wall⁵, Simpiwe Nkepu⁶, Alet Meiring^{7

8}, Michael Bestawros^{9

10}, Bongani M Mayosi¹¹

Affiliations

¹ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. liesl.zuhlke@uct.ac.za.
² Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. liesl.zuhlke@uct.ac.za.
³ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. mark.engel@uct.ac.za.
⁴ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. caroliseclintech@yahoo.com.
⁵ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. marnie.vandewall@uct.ac.za.
⁶ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. Simpiwe.nkepu@uct.ac.za.
⁷ Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa. aletmeiring@gmail.com.
⁸ Present address: Division of Cardiology, Department of Internal Medicine, Tygerberg Hospital and Stellenbosch University, Parow, South Africa. aletmeiring@gmail.com.
⁹ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. mbestaw@gmail.com.
¹⁰ Present address: New Mexico Heart Institute and the University of New Mexico, Albuquerque, NM, USA. mbestaw@gmail.com.
¹¹ The Cardiac Clinic, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa. bongani.mayosi@uct.ac.za.

PMID: 26892774
PMCID: PMC4759741
DOI: 10.1186/s12872-016-0225-3

Abstract

Background: Latent rheumatic heart disease (RHD) occurs in asymptomatic individuals with echocardiographic evidence of RHD and no history of acute rheumatic fever. The natural history of latent RHD is unclear but has important clinical and economic implications about whether these children should receive penicillin prophylaxis or not. We performed a 5-year prospective study of this question.

Methods: In August 2013 through September 2014, we conducted a follow-up study of latent RHD among school pupils using the World Heart Federation (WHF) echocardiographic criteria. Contingency tables were used to assess progression, persistence or regression of latent RHD.

Results: Forty two borderline and 13 definite cases of RHD (n 55) were identified, 44 (80%; mean age 13.8 ± 4.0 years; 29 (65.9%) female) of whom were available for echocardiographic examination at a median follow-up of 60.8 months (interquartile range 51.3-63.5). Over the follow-up period, half the participants (n = 23; 52.3%) improved to normal or better WHF category (regressors), a third (n = 14, 31.8%) remained in the same category (persistors), while seven others (15.9%) progressed from borderline to definite RHD (progressors). In total, 21 subjects (47.7%) reverted to a normal status, nine (20.4%) either improved from definite to borderline or remained in the borderline category, and 14 (31.8%) either remained definite or progressed from borderline to a definite status. Two cases (20%) progressed to symptomatic disease.

Conclusions: Latent RHD has a variable natural history that ranges from regression to normal in nearly half of cases, to persistence, progression or development of symptoms in the remainder of subjects.

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Figures

**Fig. 1**
Natural history of latent rheumatic heart disease in school pupils after 60 months of follow-up

**Fig. 2**
A comparison of the natural history of latent rheumatic heart disease in five studies with increasing durations of follow-up. Acronyms m = months of follow-up, n = sample size of follow-up cohort

See this image and copyright information in PMC

References

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The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study

Affiliations

The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study

Authors

Affiliations

Abstract

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References

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