Utility of world heart federation and modified World Health Organization echocardiographic diagnostic criteria of subclinical rheumatic heart disease in children of Manipur, India

Rajendra Singh Thangjam; Rothangpui .; Anil Irom; Rameshchandra Th; Sivasubramanian Ramakrishnan; Anita Saxena

doi:10.18203/2349-3933.ijam20191151

Authors

Rajendra Singh Thangjam Department of Medicine, Jawaharlal Institute of Medical Sciences, Imphal, India
Rothangpui . Department of Medicine, Jawaharlal Institute of Medical Sciences, Imphal, India
Anil Irom Department of Medicine, Jawaharlal Institute of Medical Sciences, Imphal, India
Rameshchandra Th Department of Medicine, Jawaharlal Institute of Medical Sciences, Imphal, India
Sivasubramanian Ramakrishnan Department of Cardiology, AIIMS, New Delhi, India
Anita Saxena Department of Cardiology, AIIMS, New Delhi, India

DOI:

https://doi.org/10.18203/2349-3933.ijam20191151

Keywords:

Echocardiography prevalence, Rheumatic heart disease, School children, Subclinical

Abstract

Background: A comparative prevalence studies using modified WHO and more stringent criteria of WHF2012 have not been conducted in this part of the country and so authors felt necessary to conduct such study in this North-eastern state of India.

Methods: In this cross-sectional study, 3600 children aged 5-15 years (11.07±2.86, 51.90% male) from randomly selected schools of Manipur were examined clinically and by 2D colour doppler echocardiography.

Results: Only one case of Clinical RHD with a combination of MR and AS was found, (prevalence of 0.28/1000) [CI: 0.04-1.97). Echocardiography detected 3 cases of definite subclinical (prevalence rate of 0.83/1000 (CI: 0.27-2.58], 14 cases of borderline subclinical RHD (prevalence rate of 3.9)/1000 (CI: 2.30-6.56) befitting WHF 2012 criteria, and 61 cases of borderline subclinical RHD befitting modified WHO criteria (prevalence rate of 16.9/1000)[ CI1.3-2.1].On follow up to 5 years, among the 3 cases with definite subclinical RHD, 2 had worsened and 1 remained non- progressive, while among the 14 subclinical borderline cases, 2 normalized, 6 remained non-progressive and 6 children were lost to follow up.

Conclusions: Prevalence of RHD using echocardiography is several folds higher compared to clinical examination alone. While the number is reduced by about half using WHF criteria. However, the important of WHO criteria cannot simply be neglected, as all the subclinical cases by WHF criteria remains non-progressive, while one case of subclinical defined by WHO worsen on follow up.

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References

Feinstein AR, Wood HF, Spagnuolo M, Taranta A, Jonas S, Kleinberg E, et al. A long-term epidemiologic study of subsequent prophylaxis, streptococcal infections, and clinical sequelae. VII. Cardiac changes and sequelae. Ann Int Med. 1964;60:87-123.

Marijon E, Ou P, Celermajer DS, Ferreira B, Mocumbi AO, Jani D, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Eng J Med. 2007;357:470-6.

Carapetis JR, Hardy M, Fakakovikaetau T, Taib R, Wilkinson L, Penny DJ, et al. Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren. Nature Rev Cardiol. 2008;5(7):411.

Marijon E, Celermajer DS, Taflet M, Mocumbi AO, Ferreira B, Sidi D, et al. Rheumatic heart disease screening by echocardiography: The inadequacy of world health organization criteria for optimizing the diagnosis of subclinical disease. Circul. 2009;120; 663-8.

Paar JA, Berrios NM, Rose JD, Cáceres M, Peña R, Pérez W, et al. Prevalence of rheumatic heart disease in children and young adults in Nicaragua. Am J Cardiol. 2010;105(12):1809-14.

Bhaya M, Panwar S, Beniwal R, Panwar RB. High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography. 2010;27(4):448-53.

Webb RH, Wilson NJ, Lennon DR, Wilson EM, Nicholson RW, Gentles TL, et al. Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic. Cardiol Young.2011;21:436-43.

Reeves BM, Kado J, Brook M. High prevalence of rheumatic heart disease in Fiji detected by echocardiography screening. J Paedia Child Heal. 2011;47(7):473-8.

World Health Organisation. Rheumatic fever and rheumatic heart disease: Report of a WHO Expert Consultation, Geneva, 29 October-1 November 2001. WHO. Available at: https://www.who.int/cardiovascular_diseases/publications/trs923/en/.

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. National Inst Allergy Infect Dis. 2006;1.

Reményi B, Wilson N, Steer A, Ferreira B, Kado J, Kumar K, et al. World heart federation criteria for echocardiographic diagnosis of rheumatic heart disease-an evidence-based guideline. Nature Rev Cardiol. 2012;9(5):297.

Saxena A, Desai A, Narvencar K, Ramakrishnan S, Thangjam RS, Kulkarni S, 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;249:438-42.

Ramakrishnan S, Kothari SS, Juneja R, Bhargava B, Saxena A, Bahl VK. Prevalence of rheumatic heart disease: has it declined in India. Natl Med J India. 2009;22(2):72-4.

Jose VJ, Gomathi M. Declining prevalence of rheumatic heart disease in rural schoolchildren in India: 2001-2002. Ind Heart J. 2003;55(2):158-60.

Misra M, Mittal M, Singh R, Verma A, Rai R, Chandra G, et al. Prevalence of rheumatic heart disease in school-going children of Eastern Uttar Pradesh. Ind Heart J. 2007;59(1):42-3.

Saxena A, Ramakrishnan S, Roy A, Seth S, Krishnan A, Misra P, et al. Prevalence and outcome of subclinical rheumatic heart disease in India: the rheumatic (rheumatic heart echo utilisation and monitoring actuarial trends in Indian children) study. Heart. 2011;97(24):2018-22.