Prevalence of rheumatic heart disease detected by echocardiographic screening
Identifieur interne : 009399 ( Main/Exploration ); précédent : 009398; suivant : 009400Prevalence of rheumatic heart disease detected by echocardiographic screening
Auteurs : Eloi Marijon [France, Mozambique] ; Phalla Ou [France, Cambodge] ; David S. Celermajer [Australie] ; Beatriz Ferreira [Mozambique] ; Ana Olga Mocumbi [Mozambique] ; Dinesh Jani [Mozambique] ; Christophe Paquet [France] ; Sophie Jacob [France] ; Daniel Sidi [France] ; Xavier Jouven [France]Source :
- The New England journal of medicine [ 0028-4793 ] ; 2007.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Médecine.
English descriptors
- KwdEn :
Abstract
BACKGROUND Epidemiologic studies of the prevalence of rheumatic heart disease have used clinical screening with echocardiographic confirmation of suspected cases. We hypothesized that echocardiographic screening of all surveyed children would show a significantly higher prevalence of rheumatic heart disease. METHODS Randomly selected schoolchildren from 6 through 17 years of age in Cambodia and Mozambique were screened for rheumatic heart disease according to standard clinical and echocardiographic criteria. RESULTS Clinical examination detected rheumatic heart disease that was confirmed by echocardiography in 8 of 3677 children in Cambodia and 5 of 2170 children in Mozambique; the corresponding prevalence rates and 95% confidence intervals (CIs) were 2.2 cases per 1000 (95% CI, 0.7 to 3.7) for Cambodia and 2.3 cases per 1000 (95% CI, 0.3 to 4.3) for Mozambique. In contrast, echocardiographic screening detected 79 cases of rheumatic heart disease in Cambodia and 66 cases in Mozambique, corresponding to prevalence rates of 21.5 cases per 1000 (95% CI, 16.8 to 26.2) and 30.4 cases per 1000 (95% CI, 23.2 to 37.6), respectively. The mitral valve was involved in the great majority of cases (87.3% in Cambodia and 98.4% in Mozambique). CONCLUSIONS Systematic screening with echocardiography, as compared with clinical screening, reveals a much higher prevalence of rheumatic heart disease (approximately 10 times as great). Since rheumatic heart disease frequently has devastating clinical consequences and secondary prevention may be effective after accurate identification of early cases, these results have important public health implications.
Affiliations:
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type="wicri:Area/Main/Exploration">009399</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Prevalence of rheumatic heart disease detected by echocardiographic screening</title><author><name sortKey="Marijon, Eloi" sort="Marijon, Eloi" uniqKey="Marijon E" first="Eloi" last="Marijon">Eloi Marijon</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Pediatric Cardiology, Hôpital Necker-Enfants Malades</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>University Paris Descartes, Georges Pompidou European Hospital</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Maputo Heart Institute</s1><s2>Maputo</s2><s3>MOZ</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Mozambique</country><wicri:noRegion>Maputo Heart Institute</wicri:noRegion></affiliation></author><author><name sortKey="Ou, Phalla" sort="Ou, Phalla" uniqKey="Ou P" first="Phalla" last="Ou">Phalla Ou</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Department of Pediatric Radiology, Hôpital Necker-Enfants Malades</s1><s2>Paris</s2><s3>FRA</s3><sZ>2 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Phnom Penh Heart Center</s1><s2>Phnom Penh</s2><s3>KHM</s3><sZ>2 aut.</sZ></inist:fA14><country>Cambodge</country><wicri:noRegion>Phnom Penh Heart Center</wicri:noRegion></affiliation></author><author><name sortKey="Celermajer, David S" sort="Celermajer, David S" uniqKey="Celermajer D" first="David S." last="Celermajer">David S. Celermajer</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Department of Medicine, Sydney University</s1><s2>Sydney</s2><s3>AUS</s3><sZ>3 aut.</sZ></inist:fA14><country>Australie</country><placeName><settlement type="city">Sydney</settlement><region type="état">Nouvelle-Galles du Sud</region></placeName></affiliation></author><author><name sortKey="Ferreira, Beatriz" sort="Ferreira, Beatriz" uniqKey="Ferreira B" first="Beatriz" last="Ferreira">Beatriz Ferreira</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Maputo Heart Institute</s1><s2>Maputo</s2><s3>MOZ</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Mozambique</country><wicri:noRegion>Maputo Heart Institute</wicri:noRegion></affiliation></author><author><name sortKey="Mocumbi, Ana Olga" sort="Mocumbi, Ana Olga" uniqKey="Mocumbi A" first="Ana Olga" last="Mocumbi">Ana Olga Mocumbi</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Maputo Heart Institute</s1><s2>Maputo</s2><s3>MOZ</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Mozambique</country><wicri:noRegion>Maputo Heart Institute</wicri:noRegion></affiliation></author><author><name sortKey="Jani, Dinesh" sort="Jani, Dinesh" uniqKey="Jani D" first="Dinesh" last="Jani">Dinesh Jani</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Maputo Heart Institute</s1><s2>Maputo</s2><s3>MOZ</s3><sZ>1 aut.</sZ><sZ>4 aut.</sZ><sZ>5 aut.</sZ><sZ>6 aut.</sZ></inist:fA14><country>Mozambique</country><wicri:noRegion>Maputo Heart Institute</wicri:noRegion></affiliation></author><author><name sortKey="Paquet, Christophe" sort="Paquet, Christophe" uniqKey="Paquet C" first="Christophe" last="Paquet">Christophe Paquet</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>National Institute for Public Health Surveillance</s1><s2>Saint Maurice</s2><s3>FRA</s3><sZ>7 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Saint Maurice</wicri:noRegion><wicri:noRegion>National Institute for Public Health Surveillance</wicri:noRegion><wicri:noRegion>National Institute for Public Health Surveillance</wicri:noRegion></affiliation></author><author><name sortKey="Jacob, Sophie" sort="Jacob, Sophie" uniqKey="Jacob S" first="Sophie" last="Jacob">Sophie Jacob</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>INSERM, Unité 780 Avenir, Cardiovascular Epidemiology</s1><s2>Villejuif</s2><s3>FRA</s3><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Cardiovascular Epidemiology</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Sidi, Daniel" sort="Sidi, Daniel" uniqKey="Sidi D" first="Daniel" last="Sidi">Daniel Sidi</name><affiliation wicri:level="3"><inist:fA14 i1="01"><s1>Department of Pediatric Cardiology, Hôpital Necker-Enfants Malades</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation></author><author><name sortKey="Jouven, Xavier" sort="Jouven, Xavier" uniqKey="Jouven X" first="Xavier" last="Jouven">Xavier Jouven</name><affiliation wicri:level="3"><inist:fA14 i1="02"><s1>University Paris Descartes, Georges Pompidou European Hospital</s1><s2>Paris</s2><s3>FRA</s3><sZ>1 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Île-de-France</region><region type="old region">Île-de-France</region><settlement type="city">Paris</settlement></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>INSERM, Unité 780 Avenir, Cardiovascular Epidemiology</s1><s2>Villejuif</s2><s3>FRA</s3><sZ>8 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Cardiovascular Epidemiology</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">The New England journal of medicine</title><title level="j" type="abbreviated">N. Engl. j. med.</title><idno type="ISSN">0028-4793</idno><imprint><date when="2007">2007</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">The New England journal of medicine</title><title level="j" type="abbreviated">N. Engl. j. med.</title><idno type="ISSN">0028-4793</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Echocardiography</term><term>Epidemiology</term><term>Heart disease</term><term>Medical screening</term><term>Medicine</term><term>Prevalence</term><term>Rheumatism</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Rhumatisme</term><term>Prévalence</term><term>Epidémiologie</term><term>Cardiopathie</term><term>Echocardiographie</term><term>Dépistage</term><term>Médecine</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Médecine</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">BACKGROUND Epidemiologic studies of the prevalence of rheumatic heart disease have used clinical screening with echocardiographic confirmation of suspected cases. We hypothesized that echocardiographic screening of all surveyed children would show a significantly higher prevalence of rheumatic heart disease. METHODS Randomly selected schoolchildren from 6 through 17 years of age in Cambodia and Mozambique were screened for rheumatic heart disease according to standard clinical and echocardiographic criteria. RESULTS Clinical examination detected rheumatic heart disease that was confirmed by echocardiography in 8 of 3677 children in Cambodia and 5 of 2170 children in Mozambique; the corresponding prevalence rates and 95% confidence intervals (CIs) were 2.2 cases per 1000 (95% CI, 0.7 to 3.7) for Cambodia and 2.3 cases per 1000 (95% CI, 0.3 to 4.3) for Mozambique. In contrast, echocardiographic screening detected 79 cases of rheumatic heart disease in Cambodia and 66 cases in Mozambique, corresponding to prevalence rates of 21.5 cases per 1000 (95% CI, 16.8 to 26.2) and 30.4 cases per 1000 (95% CI, 23.2 to 37.6), respectively. The mitral valve was involved in the great majority of cases (87.3% in Cambodia and 98.4% in Mozambique). CONCLUSIONS Systematic screening with echocardiography, as compared with clinical screening, reveals a much higher prevalence of rheumatic heart disease (approximately 10 times as great). Since rheumatic heart disease frequently has devastating clinical consequences and secondary prevention may be effective after accurate identification of early cases, these results have important public health implications.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Cambodge</li><li>France</li><li>Mozambique</li></country><region><li>Nouvelle-Galles du Sud</li><li>Île-de-France</li></region><settlement><li>Paris</li><li>Sydney</li></settlement></list><tree><country name="France"><region name="Île-de-France"><name sortKey="Marijon, Eloi" sort="Marijon, Eloi" uniqKey="Marijon E" first="Eloi" last="Marijon">Eloi Marijon</name></region><name sortKey="Jacob, Sophie" sort="Jacob, Sophie" uniqKey="Jacob S" first="Sophie" last="Jacob">Sophie Jacob</name><name sortKey="Jouven, Xavier" sort="Jouven, Xavier" uniqKey="Jouven X" first="Xavier" last="Jouven">Xavier Jouven</name><name sortKey="Jouven, Xavier" sort="Jouven, Xavier" uniqKey="Jouven X" first="Xavier" last="Jouven">Xavier Jouven</name><name sortKey="Marijon, Eloi" sort="Marijon, Eloi" uniqKey="Marijon E" first="Eloi" last="Marijon">Eloi Marijon</name><name sortKey="Ou, Phalla" sort="Ou, Phalla" uniqKey="Ou P" first="Phalla" last="Ou">Phalla Ou</name><name sortKey="Paquet, Christophe" sort="Paquet, Christophe" uniqKey="Paquet C" first="Christophe" last="Paquet">Christophe Paquet</name><name sortKey="Sidi, Daniel" sort="Sidi, Daniel" uniqKey="Sidi D" first="Daniel" last="Sidi">Daniel Sidi</name></country><country name="Mozambique"><noRegion><name sortKey="Marijon, Eloi" sort="Marijon, Eloi" uniqKey="Marijon E" first="Eloi" last="Marijon">Eloi Marijon</name></noRegion><name sortKey="Ferreira, Beatriz" sort="Ferreira, Beatriz" uniqKey="Ferreira B" first="Beatriz" last="Ferreira">Beatriz Ferreira</name><name sortKey="Jani, Dinesh" sort="Jani, Dinesh" uniqKey="Jani D" first="Dinesh" last="Jani">Dinesh Jani</name><name sortKey="Mocumbi, Ana Olga" sort="Mocumbi, Ana Olga" uniqKey="Mocumbi A" first="Ana Olga" last="Mocumbi">Ana Olga Mocumbi</name></country><country name="Cambodge"><noRegion><name sortKey="Ou, Phalla" sort="Ou, Phalla" uniqKey="Ou P" first="Phalla" last="Ou">Phalla Ou</name></noRegion></country><country name="Australie"><region name="Nouvelle-Galles du Sud"><name sortKey="Celermajer, David S" sort="Celermajer, David S" uniqKey="Celermajer D" first="David S." last="Celermajer">David S. 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