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

Marc Remond, David Atkinson, Andrew White, Alex Brown, Jonathan Carapetis, Bo (Boglarka) Remenyi, Kathryn Roberts, Graeme Maguire

    Research output: Contribution to journalArticle

    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.
    Original languageEnglish
    Pages (from-to)117-122
    Number of pages6
    JournalInternational Journal of Cardiology
    Volume198
    DOIs
    Publication statusPublished - Nov 2015

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