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A rapid echocardiographic screening protocol for rheumatic heart disease in Samoa: a high prevalence of advanced disease

Published online by Cambridge University Press:  15 June 2017

Marvin Allen ,
John Allen ,
Take Naseri ,
Rebecca Gardner ,
Dennis Tolley  and
Lori Allen
Marvin Allen*
Affiliation:
Brigham Young University, Provo, Utah, United States of America
John Allen
Affiliation:
Brigham Young University, Provo, Utah, United States of America
Take Naseri
Affiliation:
Samoan Ministries of Health, Apia, Samoa
Rebecca Gardner
Affiliation:
Department of Statistics, Brigham Young University, Provo, Utah, United States of America
Dennis Tolley
Affiliation:
Department of Statistics, Brigham Young University, Provo, Utah, United States of America
Lori Allen
Affiliation:
Department of Biology, Brigham Young University, Provo, Utah, United States of America
*
Correspondence to: M. Allen, Brigham Young University, Provo, Utah 84664, United States of America. E-mail: marvin.allen@reverehealth.com
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Abstract

Background

Echocardiography has been proposed as a method to screen children for rheumatic heart disease. The World Heart Federation has established guidelines for echocardiographic screening. In this study, we describe a rapid echocardiogram screening protocol according to the World Heart Federation guidelines in Samoa, endemic for rheumatic heart disease.

Methods

We performed echocardiogram screening in schoolchildren in Samoa between 2013 and 2015. A brief screening echocardiogram was performed on all students. Children with predefined criteria suspicious for rheumatic hear diseases were referred for a more comprehensive echocardiogram. Complete echocardiograms were classified according to the World Heart Federation guidelines and severity of valve disease.

Results

Echocardiographic screening was performed on 11,434 children, with a mean age of 10.2 years; 51% of them were females. A total of 558 (4.8%) children underwent comprehensive echocardiography, including 49 students who were randomly selected as controls. Definite rheumatic heart disease was observed in 115 students (10.0 per 1000): 92 students were classified as borderline (8.0 per 1000) and 23 with CHD. Advanced disease was identified in 50 students (4.4 per 1000): 15 with severe mitral regurgitation, five with severe aortic regurgitation, 11 with mitral stenoses, and 19 with mitral and aortic valve disease.

Conclusions

We successfully applied a rapid echocardiographic screening protocol to a large number of students over a short time period – 28 days of screening over a 3-year time period – to identify a high prevalence of rheumatic heart disease. We also reported a significantly higher rate of advanced disease compared with previously published echocardiographic screening programmes.

Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 8 , October 2017 , pp. 1599 - 1605
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Copyright
© Cambridge University Press 2017 

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References

1. Vos, T, Barber, RM, Bell, B, et al. Global Burden of Disease Study Collaborators. Global, regional, and national incidence, and prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis of the Global Burden of Disease Study 2013. Lancet 2015; 743–800.Google Scholar
2. Weinberg, J, Beaton, A, Aliku, T, Lwabi, P, Sable, C. Prevalence of rheumatic heart disease in African school-aged population: Extrapolation from echocardiography screening using the 2012 World Heart Federation Guidelines. Int J Cardiol 2016; 202: 238–239.Google Scholar
3. Marijon, E, Ou, P, Celermajer, DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007; 357: 470–476.Google Scholar
4. Carapetis, JR, Hardy, M, Fakakovikaetau, T, et al. Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren. Nat Clin Pract Cardiovasc Med 2008; 5: 411–417.Google Scholar
5. Bhaya, M, Panwar, S, Beniwal, R, Panwar, RB. High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography 2010; 27: 448–453.CrossRefGoogle ScholarPubMed
6. Carapetis, JR. Pediatric rheumatic heart disease in the developing world: echocardiographic versus clinical screening. Nat Clin Pract Cardiovasc Med 2008; 5: 74–75.CrossRefGoogle ScholarPubMed
7. Marijon, E, Celermajer, DS, Tafflet, M, et al. Rheumatic heart disease screening by echocardiography: the inadequacy of World Health Organization criteria for optimizing the diagnosis of subclinical disease. Circulation 2009; 120: 663–668.Google Scholar
8. Tompkins, DG, Bocerbaum, B, Liebman, J. Long-term prognosis of rheumatic fever patients receiving regular intramuscular benzathine penicillin. Circulation 1972; 45: 543–551.Google Scholar
9. Kassem, AS, el-Walili, TM, Zaher, SR, Ayman, M. Reversibility of mitral regurgitation following rheumatic fever: clinical profile and echocardiographic evaluation. Indian J Pediatr 1995; 62: 717–723.CrossRefGoogle ScholarPubMed
10. Organization, W. H. Rheumatic fever and rheumatic heart disease. World Health Organ Tech Rep Ser 2004; 923: 1–122.Google Scholar
11. Carapetis, JR, Paar, J, Cherian, T. Standardization of Epidemiologic Protocols for Surveillance of Post-Streptococcal Sequelae: Acute Rheumatic Fever, Rheumatic Heart Disease and Acute Post-Streptococcal Glomerulonephritis. Department of Health and Human Services, National Institute of Health, from http://www.niaid.nih.gov/topics/strepThroat/Documents/groupasequelae.pdf (2010).Google Scholar
12. Remenyi, B, Wilson, N, Steer, A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease – an evidence-based guideline. Nat Rev Cardiol 2012; 9: 297–309.CrossRefGoogle ScholarPubMed
13. Beaton, A, Aliku, T, Okello, E, et al. The utility of handheld echocardiography for early diagnosis of rheumatic heart disease. J Am Soc Echocardiogr 2014; 27: 42–29.Google Scholar
14. Colquhoun, SM, Kado, JH, Remenyi, B, Wilson, NJ, Carapetis, JR, Steer, AC. Echocardiographic screening in a resource poor setting: borderline rheumatic heart disease could be a normal variant. Int J Cardio 2014; 173: 284–289.Google Scholar
15. Mirabel, M, Fauchier, T, Bacquelin, R, et al. Echocartiography screening to detect rheumatic heart disease: a cohort study of schoolchildren in French Pacific Islands. Int J Cardiol 2015; 188: 89–95.Google Scholar
16. Engleman, D, Kado, JH, Remenyi, B, et al. Teaching focused echocardiography for rheumatic heart disease screening. Ann Pediatr Cardiol 2015; 8: 118–121.Google Scholar
17. Ploutz, M, Lu, JC, Scheel, J, et al. Handheld echocardiographic screening for rheumatic heart disease by non-experts. Heart 2015; 102: 35–39.Google Scholar
18. Enelman, D, Kdao, JH, Remenyi, B, et al. Focused cardiac ultrasound screening for rheumatic heart disease by briefly trained health workers: a study of diagnostic accuracy. Lancet 2016; 4: e386–e394.Google Scholar
19. Nishimura, RA, Otto, CM, Bonow, RO, et al. AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63: e57–e185.Google Scholar
20. Landis, JR, Koch, GG. The measurement of observer agreement for categorical data. Biometrics 1977: 159–174.CrossRefGoogle ScholarPubMed
21. Beaton, A, Lu, JC, Aliku, T, et al. The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study. Eur Heart J Cardiovasc Imaging 2015; 16: 475–482.Google Scholar
22. Roberts, K, Maguire, G, Brown, A, et al. Echocardiographic screening for rheumatic heart disease in high and low risk Australian children. Circulation 2014; 129: 1953–1961.Google Scholar
23. Engel, ME, Haileamlak, A, Zuhlke, L, et al. Prevalence of rheumatic heart disease in 4720 asymptomatic scholars from South Africa and Ethiopia. Heart 2015; 101: 1389–1394.CrossRefGoogle ScholarPubMed
24. Shrestha, NR, Karki, P, Mahto, R, et al. Prevalence of subclinical rheumatic heart disease in Eastern Nepal. JAMA Cardiol 2016; 1: 89–96.Google Scholar
25. Bacquelin, R, Tafflet, M, Rouchon, B, et al. Echocardiography-based. screening for rheumatic heart disease: What does borderline mean? Int J Cardiol 2016; 203: 1003–1004.Google Scholar
26. Parks, T, Mirabel, M, Kado, J, et al. Genone-wide association study of susceptibility to rheumatic heart disease in oceania: preliminary results. J G Heart 2016; 11: e2.Google Scholar
27. Nascimenti, B, Nunes, M, Lopes, E, et al. Rheumatic heart disease echocardiographic screening: approaching practical and affordable solutions. Heart 2015; 10: 1136.Google Scholar