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

Abstract

Introduction: Systematic echocardiographic screening of children in regions with an endemic pattern of rheumatic heart disease allows for the early detection of valvular lesions suggestive of subclinical rheumatic heart disease. The natural course of latent rheumatic heart disease is, however, incompletely understood at this time.

Methods: We performed a prospective cohort study of children detected to have echocardiographic evidence of definite or borderline rheumatic heart disease according to the World Heart Federation Criteria.

Results: Among 53 children found to have definite (36) or borderline (17) rheumatic heart disease, 44 (83%) children underwent follow-up at a median of 1.9 years (IQR 1.1-4.5). The median age of the children was 11 years (IQR 9-14) and 34 (64.2%) were girls. Among children with definite rheumatic heart disease, 21 (58.3%) were adherent to secondary antibiotic prophylaxis, 7 (19.4%) were not, information on adherence was missing in 2 (5.6%) children and 6 (16.7%) were lost to follow-up. Regression of disease was observed in 10 children (27.8%), whereas 20 children (55.6%) had stable disease. Among children adherent to secondary prophylaxis, seven (33.3%) showed regression of disease. Among children with borderline disease, seven (41.2%) showed regression of disease, three (17.6%) progression of disease, four (23.5%) remained stable and three (17.6%) were lost to follow-up. On univariate analysis, we identified no predictors of disease regression, and no predictors for lost to follow-up or non-adherence with secondary antibiotic prophylaxis.

Conclusion: Definite rheumatic heart disease showed regression in one in four children. Borderline disease was spontaneously reversible in less than half of the children and progressed to definite rheumatic heart disease in one in five children.

Trial registration number: NCT01550068.

Keywords: echocardiography; global burden of disease; mitral valve insufficiency.

Conflict of interest statement

Competing interests: TP has received research grants to the institution from Biotronik, Boston Scientific and Edwards Lifesciences, speaker fees from Biotronik and Boston Scientific, serves as a consultant for HighLife SAS, and is a proctor for Medtronic and Boston Scientific.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

(A) Spaghetti plot displaying longitudinal data of children with definite rheumatic heart disease. Blue lines indicate children that were adherent to secondary antibtiotic prophylaxis. Red lines indicate children that were non-adherent to secondary antibiotic prophylaxis. Light grey lines indicate children with missing information on adherence to secondary antibiotic prophylaxis. (B) Spaghetti plot displaying longitudinal data of children with borderline rheumatic heart disease.

Figure 2

(A) Stacked bar graph illustrating the proportion of children with definite and borderline rheumatic heart disease with regression (green), progression (red) and stable (blue) disease. Children lost to follow-up are shown in grey. (B) Stacked bar graph illustrating the proportion of children ≤10 years of age and >10 years of age with regression (green), progression (red) and stable (blue) disease. children lost to follow-up are shown in grey.