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Echocardiographic Screening of Rheumatic Heart Disease: Current Concepts and Challenges
1Division of Social Pediatrics, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey.
Insights
Early echocardiographic screening can identify rheumatic heart disease (RHD) in at-risk children, preventing severe cardiac complications. This approach is crucial for managing RHD and improving long-term outcomes in affected populations.
Area of Science:
- Cardiology
- Pediatrics
- Infectious Diseases
Background:
- Acute rheumatic fever (ARF) affects 8-51/100,000 globally, primarily children aged 5-15 after group A Streptococcus (GAS) infection.
- Rheumatic heart disease (RHD), a complication of inadequately treated ARF, is a leading cause of non-congenital heart disease in low-income countries.
- Timely GAS treatment and penicillin prophylaxis are key for ARF prevention and RHD control, yet silent RHD can lead to severe morbidity.
Purpose of the Study:
- To evaluate the feasibility of implementing echocardiographic screening programs for rheumatic heart disease (RHD).
- To address the need for early detection and prevention of cardiac morbidities associated with ARF in high-risk populations.
Main Methods:
- The study examined the applicability of echocardiographic screening programs for RHD.
- Focus on identifying asymptomatic patients and those with mild recurrent ARF symptoms who are at risk for developing severe RHD.
Main Results:
- Echocardiography is a potential tool for screening RHD, particularly in populations at moderate to high risk.
- Early detection through screening can mitigate the progression to severe cardiac involvement and long-term sequelae.
Conclusions:
- Establishing new screening programs, specifically echocardiographic screening, is recommended for preventing cardiac morbidities in ARF.
- Proactive screening and management are essential for improving outcomes in patients with or at risk for RHD.
Abstract:
The incidence of acute rheumatic fever (ARF), which most commonly affects children aged 5-15 years after group A Streptococcus (GAS) infection, ranges from 8 to 51 per 100 000 people worldwide. Rheumatic heart disease (RHD), which occurs when patients with ARF are inappropriately treated or not given regular prophylaxis, is the most common cause of non-congenital heart disease in children and young adults in low-income countries. Timely treatment of GAS infection can prevent ARF, and penicillin prophylaxis can prevent recurrence of ARF. Secondary prophylaxis with benzathine penicillin G has been shown to decrease the incidence of RHD and is a key aspect of RHD control. The most important factor determining the prognosis of RHD is the severity of cardiac involvement. Although approximately 70% of patients with carditis in the acute phase of the disease recover without sequelae, carditis is important because it is the only complication of ARF that causes sequelae. One-third of patients with ARF are asymptomatic. Patients with mild symptoms of recurrent ARF and silent RHD will develop severe morbidities within 5-10 years if they do not receive secondary preventive treatments. A new screening program should be established to prevent cardiac morbidities of ARF in moderate- and highrisk populations. In the present study, we examined the applicability of echocardiographic screening programs for RHD. Cite this article as: Topçu S, Uçar T. Echocardiographic screening of rheumatic heart disease: Current concepts and challenges. Turk Arch Pediatr. 2024;59(1):3-12.
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