Background Epidemiologic studies of the prevalence of rheumaticheart disease have used clinical screening with echocardiographicconfirmation of suspected cases. We hypothesized that echocardiographicscreening of all surveyed children would show a significantlyhigher prevalence of rheumatic heart disease.
Methods Randomly selected schoolchildren from 6 through 17 yearsof age in Cambodia and Mozambique were screened for rheumaticheart disease according to standard clinical and echocardiographiccriteria.
Results Clinical examination detected rheumatic heart diseasethat was confirmed by echocardiography in 8 of 3677 childrenin Cambodia and 5 of 2170 children in Mozambique; the correspondingprevalence rates and 95% confidence intervals (CIs) were 2.2cases per 1000 (95% CI, 0.7 to 3.7) for Cambodia and 2.3 casesper 1000 (95% CI, 0.3 to 4.3) for Mozambique. In contrast, echocardiographicscreening detected 79 cases of rheumatic heart disease in Cambodiaand 66 cases in Mozambique, corresponding to prevalence ratesof 21.5 cases per 1000 (95% CI, 16.8 to 26.2) and 30.4 casesper 1000 (95% CI, 23.2 to 37.6), respectively. The mitral valvewas involved in the great majority of cases (87.3% in Cambodiaand 98.4% in Mozambique).
Conclusions Systematic screening with echocardiography, as comparedwith clinical screening, reveals a much higher prevalence ofrheumatic heart disease (approximately 10 times as great). Sincerheumatic heart disease frequently has devastating clinicalconsequences and secondary prevention may be effective afteraccurate identification of early cases, these results have importantpublic health implications.
Source Information
From the Departments of Pediatric Cardiology (E.M., D.S.) and Pediatric Radiology (P.O.), Hôpital Necker–Enfants Malades, Paris; the University Paris Descartes, Georges Pompidou European Hospital, Paris (E.M., X.J.); the Maputo Heart Institute, Maputo, Mozambique (E.M., B.F., A.O.M., D.J.); the Phnom Penh Heart Center, Phnom Penh, Cambodia (P.O.); the Department of Medicine, Sydney University, Sydney (D.S.C.); the National Institute for Public Health Surveillance, Saint Maurice, France (C.P.); and INSERM, Unité 780 Avenir, Cardiovascular Epidemiology, Villejuif, France (S.J., X.J.).
Address reprint requests to Dr. Marijon at the Hôpital Europeén Georges Pompidou, Service de Cardiologie 2, 20 rue Leblanc, 75908 Paris CEDEX 15, France, or at eloi_marijon{at}yahoo.fr.
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