Abstract
Background. Early detection of subclinical rheumatic heart disease by use of echocardiography warrants timely implementation of secondary antibiotic prophylaxis and thereby prevents or retards its related complications. Objectives. The objective of this epidemiological study was to determine prevalence of RHD by echocardiography using World Heart Federation criteria in randomly selected school children of Trivandrum. Methods. This was a population-based cross-sectional screening study carried out in Trivandrum. A total of 2060 school children, 5–15 years, were randomly selected from five government and two private (aided) schools. All enrolled children were screened for RHD according to standard clinical and WHF criteria of echocardiography. Results. Echocardiographic examinations confirmed RHD in 5 children out of 146 clinically suspected cases. Thus, clinical prevalence was found to be 2.4 per 1000. According to WHF criteria of echocardiography, 12 children (12/2060) were diagnosed with RHD corresponding to echocardiographic prevalence of 5.83 cases per 1000. As per criteria, 6 children were diagnosed with definite RHD and 6 with borderline RHD. Conclusions. The results of the current study demonstrate that echocardiography is more sensitive and feasible in detecting clinically silent RHD. Our study, the largest school survey of south India till date, points towards declining prevalence of RHD (5.83/1000 cases) using WHF criteria in Kerala.
Highlights
Rheumatic heart disease (RHD), a consequence of valvular damage caused by an exaggerated immune response to group-A streptococcal infection, usually during childhood, still remains unabated in developing countries [1]
Early detection of subclinical RHD has been emphasized as timely implementation of secondary prevention measure is the only cost-effective approach
RHD consolidates a spectrum of different stages of clinically silent and clinically manifest valvular degeneration culminating in congestive heart failure, increasing the risk of endocarditis and cerebrovascular events and eventually leading to World Heart Federation (WHF) criteria n
Summary
Rheumatic heart disease (RHD), a consequence of valvular damage caused by an exaggerated immune response to group-A streptococcal infection, usually during childhood, still remains unabated in developing countries [1]. Several population-based surveys of the school children identified high volume of clinically unrecognized cases detected by echocardiographic screening [6,7,8,9,10]. In 2012, World Heart Federation (WHF) published evidence-based diagnostic criteria for echocardiographic detection of RHD [13]. The objective of this epidemiological study was to determine prevalence of RHD by echocardiography using World Heart Federation criteria in randomly selected school children of Trivandrum. All enrolled children were screened for RHD according to standard clinical and WHF criteria of echocardiography. According to WHF criteria of echocardiography, 12 children (12/2060) were diagnosed with RHD corresponding to echocardiographic prevalence of 5.83 cases per 1000. The results of the current study demonstrate that echocardiography is more sensitive and feasible in detecting clinically silent RHD. The largest school survey of south India till date, points towards declining prevalence of RHD (5.83/1000 cases) using WHF criteria in Kerala
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