Outcomes of Echocardiography‐Detected Rheumatic Heart Disease: Validating a Simplified Score in Cohorts From Different Countries
Background The natural history of latent rheumatic heart disease (RHD) detected by echocardiography remains unclear. We aimed to assess the accuracy of a simplified score based on the 2012 World Heart Federation criteria in predicting mid‐term RHD echocardiography outcomes in children from 4 differe...
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2021
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oai:doaj.org-article:4f3ba32110544ee7be3ec18b4fe105e82021-11-23T11:36:35ZOutcomes of Echocardiography‐Detected Rheumatic Heart Disease: Validating a Simplified Score in Cohorts From Different Countries10.1161/JAHA.121.0216222047-9980https://doaj.org/article/4f3ba32110544ee7be3ec18b4fe105e82021-09-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021622https://doaj.org/toc/2047-9980Background The natural history of latent rheumatic heart disease (RHD) detected by echocardiography remains unclear. We aimed to assess the accuracy of a simplified score based on the 2012 World Heart Federation criteria in predicting mid‐term RHD echocardiography outcomes in children from 4 different countries. Methods and Results Patient‐level baseline and follow‐up data of children with latent RHD from 4 countries (Australia, n=62; Brazil, n=197; Malawi, n=40; New Zealand, n=94) were combined. A simplified echocardiographic scoring system previously developed from Brazilian and Ugandan cohorts, consisting of 5 point‐based variables with respective weights, was applied: mitral valveanterior leaflet thickening (weight=3), excessive leaflet
tip motion (3), regurgitation jet length ≥2 cm (6), aortic valve
focal thickening (4), and any regurgitation (5). Unfavorable outcome was defined as worsening diagnostic category, persistent definite RHD or development/worsening of valve regurgitation/stenosis. The score model was updated using methods for recalibration. 393 patients (314 borderline, 79 definite RHD) with median follow‐up of 36 (interquartile range, 25–48) months were included. Median age was 14 (interquartile range, 11–16) years and secondary prophylaxis was prescribed to 16%. The echocardiographic score model applied to this external population showed significant association with unfavorable outcome (hazard ratio, 1.10; 95% CI, 1.04–1.16; P=0.001). Unfavorable outcome rates in low (≤5 points), intermediate (6–9), and high‐risk (≥10) children at 3‐year follow‐up were 14.3%, 20.8%, and 38.5% respectively (P<0.001). The updated score model showed good performance in predicting unfavorable outcome. Conclusions The echocardiographic score model for predicting RHD outcome was updated and validated for different latent RHD populations. It has potential utility in the clinical and screening setting for risk stratification of latent RHD.Bruno R. NascimentoMaria Carmo P. NunesEmily M. LimaAmy E. SanyahumbiNigel WilsonElizabeth TiltonMarc G. W. RémondGraeme P. MaguireAntonio Luiz P. RibeiroPeter N. KazembeCraig SableAndrea Z. BeatonWileyarticleechocardiographyfollow‐upprognosisrheumatic heart diseasescreeningDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 18 (2021) |
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DOAJ |
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echocardiography follow‐up prognosis rheumatic heart disease screening Diseases of the circulatory (Cardiovascular) system RC666-701 |
| spellingShingle |
echocardiography follow‐up prognosis rheumatic heart disease screening Diseases of the circulatory (Cardiovascular) system RC666-701 Bruno R. Nascimento Maria Carmo P. Nunes Emily M. Lima Amy E. Sanyahumbi Nigel Wilson Elizabeth Tilton Marc G. W. Rémond Graeme P. Maguire Antonio Luiz P. Ribeiro Peter N. Kazembe Craig Sable Andrea Z. Beaton Outcomes of Echocardiography‐Detected Rheumatic Heart Disease: Validating a Simplified Score in Cohorts From Different Countries |
| description |
Background The natural history of latent rheumatic heart disease (RHD) detected by echocardiography remains unclear. We aimed to assess the accuracy of a simplified score based on the 2012 World Heart Federation criteria in predicting mid‐term RHD echocardiography outcomes in children from 4 different countries. Methods and Results Patient‐level baseline and follow‐up data of children with latent RHD from 4 countries (Australia, n=62; Brazil, n=197; Malawi, n=40; New Zealand, n=94) were combined. A simplified echocardiographic scoring system previously developed from Brazilian and Ugandan cohorts, consisting of 5 point‐based variables with respective weights, was applied: mitral valveanterior leaflet thickening (weight=3), excessive leaflet
tip motion (3), regurgitation jet length ≥2 cm (6), aortic valve
focal thickening (4), and any regurgitation (5). Unfavorable outcome was defined as worsening diagnostic category, persistent definite RHD or development/worsening of valve regurgitation/stenosis. The score model was updated using methods for recalibration. 393 patients (314 borderline, 79 definite RHD) with median follow‐up of 36 (interquartile range, 25–48) months were included. Median age was 14 (interquartile range, 11–16) years and secondary prophylaxis was prescribed to 16%. The echocardiographic score model applied to this external population showed significant association with unfavorable outcome (hazard ratio, 1.10; 95% CI, 1.04–1.16; P=0.001). Unfavorable outcome rates in low (≤5 points), intermediate (6–9), and high‐risk (≥10) children at 3‐year follow‐up were 14.3%, 20.8%, and 38.5% respectively (P<0.001). The updated score model showed good performance in predicting unfavorable outcome. Conclusions The echocardiographic score model for predicting RHD outcome was updated and validated for different latent RHD populations. It has potential utility in the clinical and screening setting for risk stratification of latent RHD. |
| format |
article |
| author |
Bruno R. Nascimento Maria Carmo P. Nunes Emily M. Lima Amy E. Sanyahumbi Nigel Wilson Elizabeth Tilton Marc G. W. Rémond Graeme P. Maguire Antonio Luiz P. Ribeiro Peter N. Kazembe Craig Sable Andrea Z. Beaton |
| author_facet |
Bruno R. Nascimento Maria Carmo P. Nunes Emily M. Lima Amy E. Sanyahumbi Nigel Wilson Elizabeth Tilton Marc G. W. Rémond Graeme P. Maguire Antonio Luiz P. Ribeiro Peter N. Kazembe Craig Sable Andrea Z. Beaton |
| author_sort |
Bruno R. Nascimento |
| title |
Outcomes of Echocardiography‐Detected Rheumatic Heart Disease: Validating a Simplified Score in Cohorts From Different Countries |
| title_short |
Outcomes of Echocardiography‐Detected Rheumatic Heart Disease: Validating a Simplified Score in Cohorts From Different Countries |
| title_full |
Outcomes of Echocardiography‐Detected Rheumatic Heart Disease: Validating a Simplified Score in Cohorts From Different Countries |
| title_fullStr |
Outcomes of Echocardiography‐Detected Rheumatic Heart Disease: Validating a Simplified Score in Cohorts From Different Countries |
| title_full_unstemmed |
Outcomes of Echocardiography‐Detected Rheumatic Heart Disease: Validating a Simplified Score in Cohorts From Different Countries |
| title_sort |
outcomes of echocardiography‐detected rheumatic heart disease: validating a simplified score in cohorts from different countries |
| publisher |
Wiley |
| publishDate |
2021 |
| url |
https://doaj.org/article/4f3ba32110544ee7be3ec18b4fe105e8 |
| work_keys_str_mv |
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