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Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic

Published online by Cambridge University Press:  31 March 2011

Rachel H. Webb ,
Nigel J. Wilson ,
Diana R. Lennon ,
Elizabeth M. Wilson ,
Ross W. Nicholson ,
Tom L. Gentles ,
Clare P. O'Donnell ,
John W. Stirling ,
Irene Zeng  and
Adrian A. Trenholme
Rachel H. Webb
Affiliation:
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
Nigel J. Wilson*
Affiliation:
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand
Diana R. Lennon
Affiliation:
Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand KidzFirst Children's Health, Counties Manukau District Health Board, Auckland, New Zealand Department of Paediatrics, School of Population Health, University of Auckland, Auckland, New Zealand
Elizabeth M. Wilson
Affiliation:
Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
Ross W. Nicholson
Affiliation:
KidzFirst Children's Health, Counties Manukau District Health Board, Auckland, New Zealand
Tom L. Gentles
Affiliation:
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand
Clare P. O'Donnell
Affiliation:
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand
John W. Stirling
Affiliation:
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand
Irene Zeng
Affiliation:
Department of Cardiac Physiology, Green Lane Cardiac Services, Auckland City Hospital, Auckland, New Zealand
Adrian A. Trenholme
Affiliation:
KidzFirst Children's Health, Counties Manukau District Health Board, Auckland, New Zealand
*
Correspondence to: Dr N. J. Wilson, Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland District Health Board, Private Bag 92-024, Auckland, New Zealand. Tel: +64 9 367 0000; Fax: +64 9 6310785; E-mail: [email protected]
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Abstract

Aims

Echocardiography detects a greater prevalence of rheumatic heart disease than heart auscultation. Echocardiographic screening for rheumatic heart disease combined with secondary prophylaxis may potentially prevent severe rheumatic heart disease in high-risk populations. We aimed to determine the prevalence of rheumatic heart disease in children from an urban New Zealand population at high risk for acute rheumatic fever.

Methods and results

To optimise accurate diagnosis of rheumatic heart disease, we utilised a two-step model. Portable echocardiography was conducted on 1142 predominantly Māori and Pacific children aged 10–13 years. Children with an abnormal screening echocardiogram underwent clinical assessment by a paediatric cardiologist together with hospital-based echocardiography. Rheumatic heart disease was then classified as definite, probable, or possible. Portable echocardiography identified changes suggestive of rheumatic heart disease in 95 (8.3%) of 1142 children, which reduced to 59 (5.2%) after cardiology assessment. The prevalence of definite and probable rheumatic heart disease was 26.0 of 1000, with 95% confidence intervals ranging from 12.6 to 39.4. Portable echocardiography overdiagnosed rheumatic heart disease with physiological valve regurgitation diagnosed in 28 children. A total of 30 children (2.6%) had non-rheumatic cardiac abnormalities, 11 of whom had minor congenital mitral valve anomalies.

Conclusions

We found high rates of undetected rheumatic heart disease in this high-risk population. Rheumatic heart disease screening has resource implications with cardiology evaluation required for accurate diagnosis. Echocardiographic screening for rheumatic heart disease may overdiagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

Keywords

Rheumatic heart diseaseechocardiographypublic health screening
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 4 , 12 July 2011 , pp. 436 - 443
Copyright
Copyright © Cambridge University Press 2011

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References

1.Craig, EJC, Han, DY. Monitoring the Health of New Zealand Children and Young People Indicator Project. Paediatric Society of New Zealand, Auckland, 2007.Google Scholar
2.Jaine, R, Baker, M, Venugopal, K. Epidemiology of acute rheumatic fever in New Zealand 1996–2005. J Paediatr Child Health 2008; 44: 564–571.CrossRefGoogle ScholarPubMed
3.Grayson, S, Horsburgh, M, Lennon, D. An Auckland regional audit of the nurse-led rheumatic fever secondary prophylaxis programme. N Z Med J 2006; 119: U2255.Google ScholarPubMed
4.Spinetto, H. Recurrences of rheumatic fever in Auckland 1993–1999. University of Auckland, Auckland, 2003.Google Scholar
5.Lennon, D, Stewart, J, Farrell, E, Palmer, A, Mason, H. School-based prevention of acute rheumatic fever: a group randomized trial in New Zealand. Pediatr Infect Dis J 2009; 28: 787–794.CrossRefGoogle ScholarPubMed
6.Sadler, L, McCowan, L, White, H, Stewart, A, Bracken, M, North, R. Pregnancy outcomes and cardiac complications in women with mechanical, bioprosthetic and homograft valves. BJOG 2000; 107: 245–253.CrossRefGoogle ScholarPubMed
7.North, DA, Heynes, RA, Lennon, DR, Neutze, J. Analysis of costs of acute rheumatic fever and rheumatic heart disease in Auckland. N Z Med J 1993; 106: 400–403.Google ScholarPubMed
8.Figueroa, FE, Fernandez, MS, Valdes, P, et al. Prospective comparison of clinical and echocardiographic diagnosis of rheumatic carditis: long term follow up of patients with subclinical disease. Heart 2001; 85: 407–410.CrossRefGoogle ScholarPubMed
9.Wilson, N. Echocardiography and subclinical carditis: guidelines that increase sensitivity for acute rheumatic fever. Cardiol Young 2008; 18: 565–568.CrossRefGoogle ScholarPubMed
10.Abernethy, M, Bass, N, Sharpe, N, et al. Doppler echocardiography and the early diagnosis of carditis in acute rheumatic fever. Aust N Z J Med 1994; 24: 530–535.CrossRefGoogle ScholarPubMed
11.Jaffe, WM, Roche, AH, Coverdale, HA, McAlister, HF, Ormiston, JA, Greene, ER. Clinical evaluation versus Doppler echocardiography in the quantitative assessment of valvular heart disease. Circulation 1988; 78: 267–275.CrossRefGoogle ScholarPubMed
12.Atatoa-Carr, P, Lennon, D, Wilson, N. Rheumatic fever diagnosis, management, and secondary prevention: a New Zealand guideline. N Z Med J 2008; 121: 59–69.Google ScholarPubMed
13.Carapetis, JR, Brown, A, Wilson, NJ, Edwards, KN. An Australian guideline for rheumatic fever and rheumatic heart disease: an abridged outline. Med J Aust 2007; 186: 581–586.CrossRefGoogle ScholarPubMed
14.Rheumatic fever and rheumatic heart disease. World Health Organ Tech Rep Ser 2004: 1–122.Google Scholar
15.Marijon, E, Ou, P, Celermajer, DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007; 357: 470–476.CrossRefGoogle ScholarPubMed
16.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 schoolchildren. Nat Clin Pract Cardiovasc Med 2008; 5: 411–417.CrossRefGoogle ScholarPubMed
17.Statistics New Zealand. What is the Extent of Household Crowding in New Zealand? An Analysis of Household Crowding in New Zealand 1986–2001. Statistics New Zealand, Wellington, New Zealand, 2003.Google Scholar
18.Statistics New Zealand. Census of Populations and Dwellings. Statistics New Zealand, Wellington, New Zealand, 2006.Google Scholar
19. New Zealand Ministry of Education. Review of Deciles. http://www.minedu.govt.nz/educationSectors/Schools/SchoolOperations/Resourcing/OperationalFunding/Deciles/ReviewOfDecilesGeneralInformation.aspx, accessed August, 2009.Google Scholar
20.Ganninger, MHS, Gader, S. Design and Interviewer Effects in the European Social Survey. http://www.europeansocialsurvey.org/index.php?option=com, accessed August, 2009.Google Scholar
21.Carapetis, J, Parr, J, Cherian, T. Standardization of epidemiologic protocols for surveillance of post-streptococcal sequelae: acute rheumatic fever, rheumatic heart disease and acute post-streptococcal glomerulonephritis. 2010. http://www3.niaid.nih.gov/topics/strepThroat/PDF/groupASequelae.pdfGoogle Scholar
22.Lumley, T. Analysis of complex surveys. J Stat Softw 2004; 9: 1–19.CrossRefGoogle Scholar
23.Freed, LA, Levy, D, Levine, RA, et al. Prevalence and clinical outcome of mitral-valve prolapse. N Engl J Med 1999; 341: 1–7.CrossRefGoogle ScholarPubMed
24.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: 663–668.CrossRefGoogle ScholarPubMed
25.Steer, AC, Kado, J, Wilson, N, et al. High prevalence of rheumatic heart disease by clinical and echocardiographic screening among children in Fiji. J Heart Valve Dis 2009; 18: 327–335.Google ScholarPubMed
26.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: 1809–1814.CrossRefGoogle Scholar
27.Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. JAMA 1992; 268: 2069–2073.Google Scholar
28.Ferencz, C, Rubin, JD, McCarter, RJ, et al. Congenital heart disease: prevalence at livebirth. The Baltimore–Washington Infant Study. Am J Epidemiol 1985; 121: 31–36.CrossRefGoogle ScholarPubMed
29.Newman, JE, Lennon, DR, Wong-Toi, W. Patients with rheumatic fever recurrences. N Z Med J 1984; 97: 678–680.CrossRefGoogle ScholarPubMed
30.Bland, EF, Duckett Jones, T. Rheumatic fever and rheumatic heart disease; a twenty year report on 1000 patients followed since childhood. Circulation 1951; 4: 836–843.CrossRefGoogle ScholarPubMed