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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Outcomes of echocardiography-detected rheumatic heart disease: Validating a simplified score in cohorts from different countries
Journal of the American Heart Association, Volume 10, No. 18, Article e021622, Year 2021
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Description
BACKGROUND: The natural history of latent rheumatic heart disease (RHD) detected by echocardiography remains unclear. We aimed to assess the accuracy of a simplified score based on the 2012 World Heart Federation criteria in predicting mid-term RHD echocardiography outcomes in children from 4 different countries. METHODS AND RESULTS: Patient-level baseline and follow-up data of children with latent RHD from 4 countries (Australia, n=62; Brazil, n=197; Malawi, n=40; New Zealand, n=94) were combined. A simplified echocardiographic scoring system previously developed from Brazilian and Ugandan cohorts, consisting of 5 point-based variables with respective weights, was applied: mitral valveanterior leaflet thickening (weight=3), excessive leaflet tip motion (3), regurgitation jet length ≥2 cm (6), aortic valve focal thickening (4), and any regurgitation (5). Unfavorable outcome was defined as worsening diagnostic category, persistent definite RHD or development/worsening of valve regurgitation/stenosis. The score model was updated using methods for recalibration. 393 patients (314 borderline, 79 definite RHD) with median follow-up of 36 (interquartile range, 25– 48) months were included. Median age was 14 (interquartile range, 11–16) years and secondary prophylaxis was prescribed to 16%. The echocardiographic score model applied to this external population showed significant association with unfavorable outcome (hazard ratio, 1.10; 95% CI, 1.04–1.16; P=0.001). Unfavorable outcome rates in low (≤5 points), intermediate (6– 9), and high-risk (≥10) children at 3-year follow-up were 14.3%, 20.8%, and 38.5% respectively (P<0.001). The updated score model showed good performance in predicting unfavorable outcome. CONCLUSIONS: The echocardiographic score model for predicting RHD outcome was updated and validated for different latent RHD populations. It has potential utility in the clinical and screening setting for risk stratification of latent RHD. © 2021 The Authors.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC8649515/bin/JAH3-10-e021622-s001.pdf
Authors & Co-Authors
Nascimento, Bruno Ramos
Brazil, Belo Horizonte
Universidade Federal de Minas Gerais
Nunes, Maria Carmo Pereira
Brazil, Belo Horizonte
Universidade Federal de Minas Gerais
Lima, Emilly Malveira De
Brazil, Belo Horizonte
Universidade Federal de Minas Gerais
Sanyahumbi, Amy E.Sims
United States, Houston
Texas Children's Hospital
Wilson, Nigel J.
New Zealand, Auckland
Starship Children’s Hospital
Ribeiro, Antonio L.
Brazil, Belo Horizonte
Universidade Federal de Minas Gerais
Kazembe, Peter Nicholas
United States, Houston
Texas Children's Hospital
Sable, Craig Andrew
United States, Washington, D.c.
Childrens National Health System
Beaton, Andrea Zawacki
United States, Cincinnati
Cincinnati Children's Hospital Medical Center
Statistics
Citations: 7
Authors: 9
Affiliations: 7
Identifiers
Doi:
10.1161/JAHA.121.021622
ISSN:
20479980
Research Areas
Environmental
Health System And Policy
Maternal And Child Health
Noncommunicable Diseases
Study Design
Cross Sectional Study
Cohort Study
Study Locations
Malawi