Echocardiographic screening for rheumatic heart disease in high and low risk Australian children

Kathryn Roberts, Graeme Maguire, Alex Brown, David Atkinson, Bo Reményi, Gavin Wheaton, Andrew Kelly, Raman K. Kumar, Jiunn Yih Su, Jonathan R. Carapetis

Research output: Contribution to journalArticle

64 Citations (Scopus)

Abstract

Background: Echocardiographic screening for rheumatic heart disease (RHD) is becoming more widespread, but screening studies to date have used different echocardiographic definitions. The World Heart Federation has recently published new criteria for the echocardiographic diagnosis of RHD. We aimed to establish the prevalence of RHD in high-risk Indigenous Australian children using these criteria and to compare the findings with a group of Australian children at low risk for RHD. Methods and Results: Portable echocardiography was performed on high-risk Indigenous children aged 5 to15 years living in remote communities of northern Australia. A comparison group of low-risk, non-Indigenous children living in urban centers was also screened. Echocardiograms were reported in a standardized, blinded fashion. Of 3946 high-risk children, 34 met World Heart Federation criteria for definite RHD (prevalence, 8.6 per 1000 [95% confidence interval, 6.0-12.0]) and 66 for borderline RHD (prevalence, 16.7 per 1000 [95% confidence interval, 13.0-21.2]). Of 1053 low-risk children, none met the criteria for definite RHD, and 5 met the criteria for borderline RHD. High-risk children were more likely to have definite or borderline RHD than low-risk children (adjusted odds ratio, 5.7 [95% confidence interval, 2.3-14.1]; P<0.001). Conclusions: The prevalence of definite RHD in high-risk Indigenous Australian children approximates what we expected in our population, and no definite RHD was identified in the low-risk group. This study suggests that definite RHD, as defined by the World Heart Federation criteria, is likely to represent true disease. Borderline RHD was identified in children at both low and high risk, highlighting the need for longitudinal studies to evaluate the clinical significance of this finding.

LanguageEnglish
Pages1953-1961
Number of pages9
JournalCirculation
Volume129
Issue number19
DOIs
Publication statusPublished - 1 Jan 2014

Keywords

  • Echocardiography
  • Mass screening
  • Pediatrics
  • Rheumatic heart disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Roberts, K., Maguire, G., Brown, A., Atkinson, D., Reményi, B., Wheaton, G., ... Carapetis, J. R. (2014). Echocardiographic screening for rheumatic heart disease in high and low risk Australian children. Circulation, 129(19), 1953-1961. https://doi.org/10.1161/CIRCULATIONAHA.113.003495
Roberts, Kathryn ; Maguire, Graeme ; Brown, Alex ; Atkinson, David ; Reményi, Bo ; Wheaton, Gavin ; Kelly, Andrew ; Kumar, Raman K. ; Su, Jiunn Yih ; Carapetis, Jonathan R. / Echocardiographic screening for rheumatic heart disease in high and low risk Australian children. In: Circulation. 2014 ; Vol. 129, No. 19. pp. 1953-1961.
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abstract = "Background: Echocardiographic screening for rheumatic heart disease (RHD) is becoming more widespread, but screening studies to date have used different echocardiographic definitions. The World Heart Federation has recently published new criteria for the echocardiographic diagnosis of RHD. We aimed to establish the prevalence of RHD in high-risk Indigenous Australian children using these criteria and to compare the findings with a group of Australian children at low risk for RHD. Methods and Results: Portable echocardiography was performed on high-risk Indigenous children aged 5 to15 years living in remote communities of northern Australia. A comparison group of low-risk, non-Indigenous children living in urban centers was also screened. Echocardiograms were reported in a standardized, blinded fashion. Of 3946 high-risk children, 34 met World Heart Federation criteria for definite RHD (prevalence, 8.6 per 1000 [95{\%} confidence interval, 6.0-12.0]) and 66 for borderline RHD (prevalence, 16.7 per 1000 [95{\%} confidence interval, 13.0-21.2]). Of 1053 low-risk children, none met the criteria for definite RHD, and 5 met the criteria for borderline RHD. High-risk children were more likely to have definite or borderline RHD than low-risk children (adjusted odds ratio, 5.7 [95{\%} confidence interval, 2.3-14.1]; P<0.001). Conclusions: The prevalence of definite RHD in high-risk Indigenous Australian children approximates what we expected in our population, and no definite RHD was identified in the low-risk group. This study suggests that definite RHD, as defined by the World Heart Federation criteria, is likely to represent true disease. Borderline RHD was identified in children at both low and high risk, highlighting the need for longitudinal studies to evaluate the clinical significance of this finding.",
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Roberts, K, Maguire, G, Brown, A, Atkinson, D, Reményi, B, Wheaton, G, Kelly, A, Kumar, RK, Su, JY & Carapetis, JR 2014, 'Echocardiographic screening for rheumatic heart disease in high and low risk Australian children', Circulation, vol. 129, no. 19, pp. 1953-1961. https://doi.org/10.1161/CIRCULATIONAHA.113.003495

Echocardiographic screening for rheumatic heart disease in high and low risk Australian children. / Roberts, Kathryn; Maguire, Graeme; Brown, Alex; Atkinson, David; Reményi, Bo; Wheaton, Gavin; Kelly, Andrew; Kumar, Raman K.; Su, Jiunn Yih; Carapetis, Jonathan R.

In: Circulation, Vol. 129, No. 19, 01.01.2014, p. 1953-1961.

Research output: Contribution to journalArticle

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AU - Maguire, Graeme

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AU - Atkinson, David

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AU - Kelly, Andrew

AU - Kumar, Raman K.

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AU - Carapetis, Jonathan R.

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N2 - Background: Echocardiographic screening for rheumatic heart disease (RHD) is becoming more widespread, but screening studies to date have used different echocardiographic definitions. The World Heart Federation has recently published new criteria for the echocardiographic diagnosis of RHD. We aimed to establish the prevalence of RHD in high-risk Indigenous Australian children using these criteria and to compare the findings with a group of Australian children at low risk for RHD. Methods and Results: Portable echocardiography was performed on high-risk Indigenous children aged 5 to15 years living in remote communities of northern Australia. A comparison group of low-risk, non-Indigenous children living in urban centers was also screened. Echocardiograms were reported in a standardized, blinded fashion. Of 3946 high-risk children, 34 met World Heart Federation criteria for definite RHD (prevalence, 8.6 per 1000 [95% confidence interval, 6.0-12.0]) and 66 for borderline RHD (prevalence, 16.7 per 1000 [95% confidence interval, 13.0-21.2]). Of 1053 low-risk children, none met the criteria for definite RHD, and 5 met the criteria for borderline RHD. High-risk children were more likely to have definite or borderline RHD than low-risk children (adjusted odds ratio, 5.7 [95% confidence interval, 2.3-14.1]; P<0.001). Conclusions: The prevalence of definite RHD in high-risk Indigenous Australian children approximates what we expected in our population, and no definite RHD was identified in the low-risk group. This study suggests that definite RHD, as defined by the World Heart Federation criteria, is likely to represent true disease. Borderline RHD was identified in children at both low and high risk, highlighting the need for longitudinal studies to evaluate the clinical significance of this finding.

AB - Background: Echocardiographic screening for rheumatic heart disease (RHD) is becoming more widespread, but screening studies to date have used different echocardiographic definitions. The World Heart Federation has recently published new criteria for the echocardiographic diagnosis of RHD. We aimed to establish the prevalence of RHD in high-risk Indigenous Australian children using these criteria and to compare the findings with a group of Australian children at low risk for RHD. Methods and Results: Portable echocardiography was performed on high-risk Indigenous children aged 5 to15 years living in remote communities of northern Australia. A comparison group of low-risk, non-Indigenous children living in urban centers was also screened. Echocardiograms were reported in a standardized, blinded fashion. Of 3946 high-risk children, 34 met World Heart Federation criteria for definite RHD (prevalence, 8.6 per 1000 [95% confidence interval, 6.0-12.0]) and 66 for borderline RHD (prevalence, 16.7 per 1000 [95% confidence interval, 13.0-21.2]). Of 1053 low-risk children, none met the criteria for definite RHD, and 5 met the criteria for borderline RHD. High-risk children were more likely to have definite or borderline RHD than low-risk children (adjusted odds ratio, 5.7 [95% confidence interval, 2.3-14.1]; P<0.001). Conclusions: The prevalence of definite RHD in high-risk Indigenous Australian children approximates what we expected in our population, and no definite RHD was identified in the low-risk group. This study suggests that definite RHD, as defined by the World Heart Federation criteria, is likely to represent true disease. Borderline RHD was identified in children at both low and high risk, highlighting the need for longitudinal studies to evaluate the clinical significance of this finding.

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