Article Text
Abstract
Objective Rheumatic heart disease (RHD) remains a major health problem in many low-income and middle-income countries. The use of echocardiographic imaging suggests that subclinical disease is far more widespread than previously appreciated, but little is known as to how these mild forms of RHD progress. We have determined the prevalence of subclinical RHD in a large group of schoolchildren in Aswan, Egypt and have evaluated its subsequent progression.
Methods Echocardiographic screening was performed on 3062 randomly selected schoolchildren, aged 5–15 years, in Aswan, Egypt. Follow-up of children with a definite or borderline diagnosis of RHD was carried out 48–60 months later to determine how the valvular abnormalities altered and to evaluate the factors influencing progression.
Results Sixty children were initially diagnosed with definite RHD (19.6 per 1000 children) and 35 with borderline disease (11.4 per 1000); most had mitral valve disease. Of the 72 children followed up progression was documented in 14 children (19.4%) and regression in 30 (41.7%) children. Boys had lower rates of progression while older children had lower rates of regression. Functional defects of the valve even in the presence of structural features were associated with lower rates of progression and higher rates of regression than structural changes.
Conclusions RHD has a high prevalence in Egypt. Although a high proportion of the abnormalities originally detected persisted at follow-up, both progression and regression of valve lesions were demonstrated.
- echocardiography
- epidemiology
- rheumatic heart disease
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Footnotes
Contributors SK: carried out the echocardiographic screening; responsible for the overall content. KS and AA: reviewed the echocardiograms. SK, DIP and HM: carried out the analysis. SK, DIP and MY: wrote the manuscript. All authors: read and approved the final version.
Funding The study was funded by Aswan Heart Centre.
Competing interests None declared.
Patient consent Guardian consent obtained.
Ethics approval Ministry of Health.
Provenance and peer review Commissioned; internally peer reviewed.
Data sharing statement Data will be made available upon request.