The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study

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dc.contributor.authorZühlke, Liesl
dc.contributor.authorEngel, Mark E
dc.contributor.authorLemmer, Carolina E
dc.contributor.authorvan de Wall, Marnie
dc.contributor.authorNkepu, Simpiwe
dc.contributor.authorMeiring, Alet
dc.contributor.authorBestawros, Michael
dc.contributor.authorMayosi, Bongani M
dc.date.accessioned2016-05-25T11:02:08Z
dc.date.available2016-05-25T11:02:08Z
dc.date.issued2016-02-19
dc.date.updated2016-05-18T15:51:04Z
dc.description.abstractBackground: Latent rheumatic heart disease (RHD) occurs in asymptomatic individuals with echocardiographic evidence of RHD and no history of acute rheumatic fever. The natural history of latent RHD is unclear but has important clinical and economic implications about whether these children should receive penicillin prophylaxis or not. We performed a 5-year prospective study of this question. Methods: In August 2013 through September 2014, we conducted a follow-up study of latent RHD among school pupils using the World Heart Federation (WHF) echocardiographic criteria. Contingency tables were used to assess progression, persistence or regression of latent RHD. Results: Forty two borderline and 13 definite cases of RHD (n 55) were identified, 44 (80 %; mean age 13.8 ± 4.0 years; 29 (65.9 %) female) of whom were available for echocardiographic examination at a median follow-up of 60.8 months (interquartile range 51.3-63.5). Over the follow-up period, half the participants (n = 23; 52.3 %) improved to normal or better WHF category (regressors), a third (n = 14, 31.8 %) remained in the same category (persistors), while seven others (15.9 %) progressed from borderline to definite RHD (progressors). In total, 21 subjects (47.7 %) reverted to a normal status, nine (20.4 %) either improved from definite to borderline or remained in the borderline category, and 14 (31.8 %) either remained definite or progressed from borderline to a definite status. Two cases (20 %) progressed to symptomatic disease. Conclusions: Latent RHD has a variable natural history that ranges from regression to normal in nearly half of cases, to persistence, progression or development of symptoms in the remainder of subjects.en_ZA
dc.identifier.apacitationZühlke, L., Engel, M. E., Lemmer, C. E., van de Wall, M., Nkepu, S., Meiring, A., ... Mayosi, B. M. (2016). The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study. <i>BMC Cardiovascular Disorders</i>, http://hdl.handle.net/11427/19846en_ZA
dc.identifier.chicagocitationZühlke, Liesl, Mark E Engel, Carolina E Lemmer, Marnie van de Wall, Simpiwe Nkepu, Alet Meiring, Michael Bestawros, and Bongani M Mayosi "The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study." <i>BMC Cardiovascular Disorders</i> (2016) http://hdl.handle.net/11427/19846en_ZA
dc.identifier.citationZühlke, L., Engel, M. E., Lemmer, C. E., van de Wall, M., Nkepu, S., Meiring, A., ... & Mayosi, B. M. (2016). The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study. BMC cardiovascular disorders, 16(1), 46.en_ZA
dc.identifier.issn1471-2261en_ZA
dc.identifier.ris TY - Journal Article AU - Zühlke, Liesl AU - Engel, Mark E AU - Lemmer, Carolina E AU - van de Wall, Marnie AU - Nkepu, Simpiwe AU - Meiring, Alet AU - Bestawros, Michael AU - Mayosi, Bongani M AB - Background: Latent rheumatic heart disease (RHD) occurs in asymptomatic individuals with echocardiographic evidence of RHD and no history of acute rheumatic fever. The natural history of latent RHD is unclear but has important clinical and economic implications about whether these children should receive penicillin prophylaxis or not. We performed a 5-year prospective study of this question. Methods: In August 2013 through September 2014, we conducted a follow-up study of latent RHD among school pupils using the World Heart Federation (WHF) echocardiographic criteria. Contingency tables were used to assess progression, persistence or regression of latent RHD. Results: Forty two borderline and 13 definite cases of RHD (n 55) were identified, 44 (80 %; mean age 13.8 ± 4.0 years; 29 (65.9 %) female) of whom were available for echocardiographic examination at a median follow-up of 60.8 months (interquartile range 51.3-63.5). Over the follow-up period, half the participants (n = 23; 52.3 %) improved to normal or better WHF category (regressors), a third (n = 14, 31.8 %) remained in the same category (persistors), while seven others (15.9 %) progressed from borderline to definite RHD (progressors). In total, 21 subjects (47.7 %) reverted to a normal status, nine (20.4 %) either improved from definite to borderline or remained in the borderline category, and 14 (31.8 %) either remained definite or progressed from borderline to a definite status. Two cases (20 %) progressed to symptomatic disease. Conclusions: Latent RHD has a variable natural history that ranges from regression to normal in nearly half of cases, to persistence, progression or development of symptoms in the remainder of subjects. DA - 2016-02-19 DB - OpenUCT DO - 10.1186/s12872-016-0225-3 DP - University of Cape Town J1 - BMC Cardiovascular Disorders KW - Latent rheumatic heart disease KW - Natural history KW - Outcome LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 SM - 1471-2261 T1 - The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study TI - The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study UR - http://hdl.handle.net/11427/19846 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1186/s12872-016-0225-3
dc.identifier.urihttp://hdl.handle.net/11427/19846
dc.identifier.vancouvercitationZühlke L, Engel ME, Lemmer CE, van de Wall M, Nkepu S, Meiring A, et al. The natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational study. BMC Cardiovascular Disorders. 2016; http://hdl.handle.net/11427/19846.en_ZA
dc.languageengen_ZA
dc.language.rfc3066en
dc.publisherBioMed Centralen_ZA
dc.publisher.departmentDepartment of Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsCreative Commons Attribution 4.0 International (CC BY 4.0)*
dc.rights.holderZühlke et al.
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_ZA
dc.sourceBMC Cardiovascular Disordersen_ZA
dc.source.urihttp://bmccardiovascdisord.biomedcentral.com/
dc.subjectLatent rheumatic heart disease
dc.subjectNatural history
dc.subjectOutcome
dc.titleThe natural history of latent rheumatic heart disease in a 5 year follow-up study: a prospective observational studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetype
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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