Skip to main content Accessibility help
×
Home

Echocardiographic screening for rheumatic heart disease in Turkish schoolchildren

  • Semra Atalay (a1), Ercan Tutar (a1), Tayfun Uçar (a1), Seda Topçu (a2), Serdal K. Köse (a1) and Melih T. Doğan (a1)...

Abstract

Background:

The aim of this study is to investigate the prevalence of subclinical rheumatic heart disease in schoolchildren aged 5–18 by using portable echocardiography in Ankara, Turkey.

Methods:

The portable echocardiography screening was performed by a paediatric cardiologist for all of the cases. The mean age of 2550 healthy students was 11.09 ± 2.91 years (1339 females, 1211 males) in three private and three public schools. Echocardiographic studies were assessed according to 2012 World Heart Federation criteria for rheumatic heart disease.

Results:

After reviewing the echocardiographic images, 73 students were reevaluated by an advanced echocardiography device in the university hospital. Evidence of definite subclinical rheumatic heart disease was found in 39 students (15/1000) and borderline rheumatic heart disease in 20 students (8/1000). No children had any clinical symptoms. The mean age of children diagnosed with rheumatic heart disease and borderline rheumatic heart disease is 12.4 and 11.4 years, respectively. The risk of rheumatic heart disease was found to be increased sevenfold in girls between 14 and 18 years. We surprisingly observed that the prevalence of definite rheumatic heart disease in private schools located in high-income areas of Ankara was higher than that in public schools.

Conclusions:

This is the first and largest single-centred echocardiographic screening study for subclinical rheumatic heart disease in Turkish schoolchildren. The frequency of rheumatic heart disease has been found to be 15/1000. This finding is similar to those of recent echocardiographic screening studies performed in middle and high-risk populations. We conclude that to decrease the burden of rheumatic heart disease, echocardiographic screening studies are necessary, and long-term follow-up of children with echocardiographically diagnosed subclinical rheumatic heart disease is needed.

Copyright

Corresponding author

Author for Correspondence: Seda Topçu, MD, Associate Professor, Division of Social Pediatrics, Department of Pediatrics, Ankara University School of Medicine, 1549. Cadde, Hardem Apartmanı, B Blok, Daire 12. Çiğdem-Çankaya, Ankara, Turkey. Tel.: +90 505 706 46 32; Fax: +90 312 306 59 17; E-mail: mdsedatopcu@gmail.com

References

Hide All
1. Carapetis, JR, Currie, BJ, Mathews, JD. Cumulative incidence of rheumatic fever in an endemic region: A guide to the susceptibility of the population? Epidemiol Infect 2000; 124: 239244.
2. Carapetis, JR. Rheumatic heart disease in developing countries. N Engl J Med 2007; 357:439441.
3. de Dassel, JL, Ralph, AP, Carapetis, JR. Controlling acute rheumatic fever and rheumatic heart disease in developing countries: Are we getting closer? Curr Opin Pediatr 2015; 27:116123.
4. Carapetis, JR, Beaton, A, Cunningham, MW, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers 2016; 2: 15084.
5. 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 school children. Nat Clin Pract Cardiovasc Med 2008; 5:411417.
6. Marijon, E, Tafflet, M, Jouven, X. Time to use ultrasound and not stethoscopes for rheumatic heart disease screening. Nat Clin Pract Cardiovasc Med 2008; 5: E1E3.
7. Paar, JA, Berrios, NM, Rose, JD, et al. Prevalence of rheumatic heart disease in children and young adults in Nicaragua. Am J Cardiol 2010; 105: 18091814.
8. Webb, RH, Gentles, TL, Stirling, JW, Lee, M, O’Donnell, C and Wilson, NJ. Valvular regurgitation using portable echocardiography in a healthy student population: implications for rheumatic heart disease screening. J Am Soc Echocardiogr 2015; 28: 981988.
9. 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: 475482.
10. Reményi, 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: 297309.
11. Imamoğlu, A, Ozen, S. Epidemiology of rheumatic heart disease. Arch Dis Child 1988; 63: 15011503.
12. Olguntürk, R, Aydın, GB,Tunaoğlu, FS, Akalın, N. Rheumatic heart disease prevalence among schoolchildren in Ankara, Turkey. Turk J Pediatr 1999; 41: 201206.
13. Sika-Paotuni, D, Beaton, A, Raghu, A, Steer, A, Carapetis, J. Acute rheumatic fever and rheumatic heart disease. In: Ferretti, J, Stevens, DL, Fischetti, VA (eds). Streptococcus Pyogenes: Basic Biology to Clinical Manifestations, vol. 10. University of Oklahoma Health Sciences Center, Oklahoma City, OK, 2016–2017, 157.
14. Beaton, A, Okello, E, Aliku, T, et al. Latent rheumatic heart disease: Outcomes 2 years after echocardiographic detection. Pediatr Cardiol 2014; 35: 12591267.
15. Zühlke, L, Mayosi, BM. Echocardiographic screening for subclinical rheumatic heart disease remains a research tool pending studies of impact on prognosis. Curr Cardiol Rep 2013; 15: 17.
16. Bahaya, M, Panwar, S, Beniwal, R, Panvar, RB. High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography 2010; 27: 448453.
17. Rothenbühler, M, O’Sullivan, CJ, Stortecky, S, et al. Active surveillance for rheumatic heart disease in endemic regions: A systematic review and meta-analysis of prevalence among children and adolescents. Lancet Glob Health 2014; 2: e717e726.
18. Anabwani, GM, Bonhoeffer, P. Prevalence of heart disease in school children in rural Kenya using colour-flow echocardiography. East Ast Afr Med J 1996; 73: 215217.
19. Saxena, A, Zühlke, L, Wilson, N. Echocardiographic screening for rheumatic heart disease: issues for the cardiology community. Glob Heart 2013; 8: 197202.
20. Huang, JH, Favazza, M, Legg, A, et al. Echocardiographic screening of rheumatic heart disease in American Samoa. Pediatr Cardiol 2018; 39: 3844.
21. Reeves, BM, Kado, J, Brook, M. High prevalence of rheumatic heart disease in Fiji detected by echocardiography screening. J Paediatr Child Health 2011; 47: 473478.
22. WHO Expert Consultation on Rheumatic Fever (RF) and Rheumatic Heart Disease (RHD). Geneva Swithzerland. Rheumatic Fever and Rheumatic Heart Disease: Report of a WHO Expert Consultation, Geneva, 29 October to 1 November 2001. WHO Technical Report Series; 923. Swithzerland World Heart Organisation, Geneva, 2001.
23. Marijon, E, Ou, P, Celermajer, DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Eng Med 2007; 357: 470476.
24. Sadoh, WE, Omuemu, VO, Israel-aina, YT. Prevalence of rheumatic heart disease among primary school pupils in mid-western Nigeria. East Afr Med J 2013; 90: 2832.
25. Cramp, G, Stonehouse, M, Webb, R, Webb, R, Chaffey-Aupouri, G, Wilson, N. Undetected rheumatic heart disease revealed using portable echocardiography in a population of school students in Tairawhiti, New Zealand. N Z Med J 2012; 125: 5364.
26. 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: 663668.
27. Beaton, A, Okello, E, Lwabi, P, Mondo, C, McCarter, R, Sable, C. Echocardiography screening for rheumatic heart disease in Ugandan school children. Circulation 2012; 125: 31273132.
28. Webb, RH, Wilson, NJ, Lennon, DR, Wilson, EM, Nicholson, RW. Optimising echocardiographic screening for rheumatic heart disease in New Zealand: Not all valve disease is rheumatic. Cardiol Young 2011; 21: 436443.
29. Saxena, A, Desai, A, Narvencar, K, et al. Echocardiographic prevalence of rheumatic heart disease in Indian school children using World Heart Federation criteria – a multi site extension of RHEUMATIC study (the e-RHEUMATIC study). Int J Cardiol 2017; 249: 438442.
30. Nascimento, BR, Sable, C, Nunes, MC, et al. Comparison between different strategies of rheumatic heart disease echocardiographic screening in Brazil: Data from the PROVAR (Rheumatic Valve Disease Screening Program) study. Am Heart Assoc 2018; 7: e008039.
31. Davis, K, Remenyi, B, Draper, AD, et al. Rheumatic heart disease in Timor-Leste school students: an echocardiography-based prevalence study. Med J Aust 2018; 208: 303307.
32. Roberts, K, Cannon, J, Atkinson, D, et al. Echocardiographic screening for rheumatic heart disease in indigenous australian children: A cost-utility analysis. J Am Heart Assoc 2017; 6: e004515.
33. Roberts, K, Maguire, G, Brown, A, et al. Echocardiographic screening for rheumatic heart disease in high and low risk Australian children. Circulation 2014; 129: 19531961.
34. Kotit, S, Said, K, ElFaramawy, A, Mahmoud, H, Phillips, DIW, Yacoub, MH. Prevalence and prognostic value of echocardiographic screening for rheumatic heart disease. Open Heart 2017; 4: e000702.
35. Ali, S, Domi, S,Abbo, B, et al. Echocardiographic screening for rheumatic heart disease in 4 515 Sudanese school children: marked disparity between two communities. Cardiovasc J Afr 2018; 29(5): 273277.
36. Periwal, KL, Gupta, BK, Panwar, RB, Khatri, PC, Raja, S, Gupta, R. Prevalence of rheumatic heart disease in school children in Bikaner: An echocardiographic study. J Assoc Physicians India 2006; 54: 279282.
37. Ayabakan, C, Ozkutlu, S, Kılıc, A. The Doppler echocardiographic assessment of valvular regurgitation in normal children. Turk J Pediatri 2003; 45: 102107.
38. Thomson, JD, Allen, J, Gibbs, JL. Left sided valvar regurgitation in normal children and adolescents. Heart 2000; 83: 185187.
39. Bhaya, M, Beniwal, R, Panwar, S, Panwar, RB. Two years of follow-up validates the echocardiographic criteria for the diagnosis and screening of rheumatic heart disease in asymptomatic populations. Echocardiography 2011; 28: 929933.
40. Rémond, M, Atkinson, D, White, A, et al. Are minor echocardiographic changes associated with an increased risk of acute rheumatic fever or progression to rheumatic heart disease? Int J Cardiol 2015; 198: 117122.
41. Pekpak, E, Atalay, S, Karadeniz, C, Demir, F, Tutar, E, Uçar, T. Rheumatic silent carditis: echocardiographic diagnosis and prognosis of long-term follow up. Pediatr Int 2013; 55: 685689.
42. World Heart Organisation. Rheumatic Fever and Rheumatic Heart Disease: Report of a WHO Expert Consultation. World Heart Organ Technical Report Series 923, 2004.
43. Engelman, D, Mataika, RL, Kado, JH, et al. Adherence to secondary antibiotic prophylaxis for patients with rheumatic heart disease diagnosed through screening in Fiji. Trop Med Int Health 2016; 21: 15831591.

Keywords

Echocardiographic screening for rheumatic heart disease in Turkish schoolchildren

  • Semra Atalay (a1), Ercan Tutar (a1), Tayfun Uçar (a1), Seda Topçu (a2), Serdal K. Köse (a1) and Melih T. Doğan (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed