Two-year evolution of latent rheumatic heart disease in Malawi
Two-year evolution of latent rheumatic heart disease in Malawi
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DOI：
10.1111/chd.12756
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发表时间：
2019-07-01
影响因子：
0.3
通讯作者：
Kazembe, Peter N.
中科院分区：
文献类型：
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作者：
Sanyahumbi, Amy;Beaton, Andrea;Kazembe, Peter N.
背景在无症状儿童中，筛查超声心动图已被用于早期诊断风湿性心脏病(RHD)(潜伏性RHD)。世界心脏联合会指南根据ECHO结果对明确、临界或无风湿性心脏病进行了标准化分类。通过回声筛查诊断的风湿性心脏病的进展尚不清楚。2014年，我们在马拉维对1450名学龄儿童进行了筛查。我们的目标是评估通过筛查确诊的风湿性心脏病患者的2年风湿性心脏病的演变。确定组和临界组的进展或回归均以表格形式列出。比较明确的风湿性心脏病患者和无明确诊断的风湿性心脏病患者的青霉素依从性、年龄、性别、家庭户数和家庭收入。我们利用了当地用于跟踪艾滋病毒违约者的系统，以便将参与者带回护理中心。结果39例临界风湿性心脏病患者中，失访1例(2.6%)，进展明确1例(2.6%)，边缘19例(48.7%)，恢复正常17例(43.6%)，二尖瓣脱垂1例(2.6%)。11例明确的风湿性心脏病患者中，6例(54.5%)病情稳定，4例(36.4%)转至临界值，1例(9.1%)转至正常。在11例明确的风湿性心脏病患者中，2例在2年的随访期内青霉素依从性超过80%。明确的风湿性心脏病退行性到临界者和非临界者在依从性、性别、年龄、家庭收入或家庭户数方面没有差异(P&>.19)。我们研究的一个优点是保留率很高(98%)。需要更长的随访时间来确定预期的疾病演变。
BackgroundIn asymptomatic children, screening echocardiography has been used to attempt to diagnose rheumatic heart disease (RHD) at an early stage (latent RHD). World Heart Federation guidelines have standardized categorization of definite, borderline, or no RHD by echo findings. The progression of RHD diagnosed through echo screening is not known. In 2014, we screened 1450 schoolchildren in Malawi.ObjectiveOur objective was to evaluate 2-year RHD evolution among those diagnosed through screening.MethodsTwo-year follow-up echocardiograms of those diagnosed with latent RHD were read by a primary, secondary, then third reader if there was disagreement. Progression or regression of both definite and borderline groups were tabulated. Penicillin adherence, age, gender, number in home, and household income were compared between those with definite RHD who regressed to borderline and those that stayed definite. We utilized the local system used to track HIV defaulters in order to bring participants back into care. Comparisons were made using Fisher's exact and Wilcoxon rank-sum tests.ResultsOf the 39 with borderline RHD, 1 was lost to follow-up (2.6%), 1 progressed to definite (2.6%), 19 remained borderline (48.7%), 17 (43.6%) regressed to normal, and 1 was reclassified as mitral valve prolapse (2.6%). Of the 11 with definite RHD, 6 (54.5%) remained definite, 4 regressed to borderline (36.4%), and 1 regressed to normal (9.1%). Two of 11 with definite RHD had penicillin adherence above 80% for the 2-year follow-up period. There were no differences in adherence, gender, age, household income, or number in household between those with definite RHD that regressed to borderline and those who did not (P>.19).ConclusionsBorderlines had a very low progression rate to definite RHD. A strength of our study was a high retention rate (98%). Longer follow-up is needed to determine expected disease evolution.