P5442Prevalence and prognostic value of echocardiographic screening for RHD in Aswan school children

Abstract

Introduction: Rheumatic heart disease (RHD) remains an important public health problem in many low and middle income countries, where it is one of the most frequent causes of heart disease especially in young people. A number of echocardiographic screening studies carried out in children and young adults have suggested that subclinical RHD is far more widespread than may be detected clinically. However, there is still uncertainty as to the prognostic significance of subclinical disease detected in this way and consequently whether echocardiographic screening programs could be a valuable tool for the early detection of clinically important disease. Purpose: The aim of this study was to perform systematic echocardiographic screening for RHD in a large sample of schoolchildren in Aswan to determine its prevalence, severity and form of valvular disease and, in a follow-up study, to evaluate how these findings changed up to five years later. Methods: A systematic cross-sectional echocardiographic screening study was performed in 3062 randomly selected schoolchildren, aged 5 to 15 years, in Aswan, Egypt. The diagnosis of RHD was based on the current WHF criteria and the images obtained were reviewed by two senior cardiologists. Follow-up of children with a definite or possible diagnosis of RHD together and a control group of 80 normal children was carried out 48 to 60 months later using the same techniques. The initial screening was carried out when the children were aged 10±2.6 years, with a slight male predominance (58.7%, n=1796). Sixty children were diagnosed with definite RHD (19.6 per 1000) and 35 with possible disease (11.4 per 1000). Most children had mitral valve disease (n=68, 97.1%). Of the 72 children followed up progression was documented in 14 children (19.4%) and regression in 30 (41.7%) children. Rates of progression and regression were related to both gender and age. Boys had lower rates of progression while older children had lower rates of regression (regression was seen in 23 out of 30 children (76.7%) studied at the age of 10-15 years compared to only 7 out of 30 (23.3%) in the age group 16-19 years, P<0.001). Children with functional defects of the valve also tended to show lower rates of progression than the children with structural changes. The 72 cases of possible or definite RHD were stratified into two subgroups based on the presence or absence of MR. Of the 57 cases with MR, nine (16%) had progression of their disease compared with five out of fifteen (33%) cases who did not have MR, of which four had definite RHD. Conclusions: Our study shows a high prevalence of subclinical RHD in school children in urban Aswan. Although a high proportion of the abnormalities originally detected persisted at follow-up, both progression and regression of valve lesions was demonstrated. Disease progression and regression seem related to gender, age and the presence of initial mitral regurgitation.