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Mid-term outcome of children with latent rheumatic heart disease in eastern Nepal

Nikesh Raj Shrestha1, Dorothea Bruelisauer2, Surendra Uranw3

  • 1Department of Cardiology, Neuro Cardio and Multispeciality Hospital, Biratnagar, Nepal.

Open Heart
|April 6, 2021
PubMed

Insights

Early echocardiographic screening detects subclinical rheumatic heart disease in children. Definite rheumatic heart disease regressed in 27.8% of cases, while borderline cases showed spontaneous reversibility in less than half.

Area of Science:

  • Pediatric Cardiology
  • Rheumatic Heart Disease Epidemiology
  • Echocardiography

Background:

  • Rheumatic heart disease (RHD) is a significant global health concern, particularly in endemic regions.
  • Early detection of subclinical RHD through echocardiography is crucial for timely intervention.
  • The natural history of latent RHD in children requires further elucidation.

Purpose of the Study:

  • To prospectively investigate the course of subclinical rheumatic heart disease detected by echocardiography in children.
  • To assess disease regression, progression, and stability in definite and borderline RHD cases.
  • To identify potential predictors of disease course and adherence to secondary antibiotic prophylaxis.

Main Methods:

  • Prospective cohort study involving children with echocardiographic evidence of definite or borderline RHD based on World Heart Federation Criteria.
  • Follow-up assessments were conducted to evaluate valvular lesions and clinical status.
  • Statistical analysis, including univariate analysis, was performed to identify predictors.

Main Results:

  • Of 53 children with definite (36) or borderline (17) RHD, 44 were followed for a median of 1.9 years.
  • Definite RHD regressed in 27.8% of cases; 55.6% had stable disease.
  • Borderline RHD showed regression in 41.2%, progression in 17.6%, and stability in 23.5%.

Conclusions:

  • Definite rheumatic heart disease regressed in approximately one in four children.
  • Borderline RHD demonstrated spontaneous reversibility in less than half of cases, with progression to definite RHD in one in five.
  • No predictors for disease regression or adherence issues were identified.
Abstract

Keywords:
echocardiographyglobal burden of diseasemitral valve insufficiency

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