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RHEUMATIC HEART DISEASE SCREENING IN SCHOOLS THROUGH PORTABLE ECHOCARDIOGRAPHY IN BRAZIL: DATA FROM THE PROVAR STUDY
1567 JACC April 5, 2016 Volume 67, Issue 13
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) RHEUMATIC HEART DISEASE SCREENING IN SCHOOLS THROUGH PORTABLE ECHOCARDIOGRAPHY IN BRAZIL: DATA FROM THE PROVAR STUDY Moderated Poster Contributions Non Invasive Imaging Moderated Poster Theater, Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-9:55 a.m. Session Title: Advances in Echocardiography Abstract Category: 29. Non Invasive Imaging: Echo Presentation Number: 1199M-01 Authors: Bruno Ramos Nascimento, Andrea Beaton, Maria do Carmo Nunes, Adriana Diamantino, Kaciane K. Oliveira, Cassio M. Oliveira, Vitoria M. Rezende, Eduardo L. Lopes, Amanda O. Lauar, Luise C. Barros, Michelle C. Galbas, Lindsay Perlman, Antonio Ribeiro, Craig Sable, Hospital das Cinicas da Univeresidade Federal de Minas Gerais, Belo Horizonte, Brazil, Childrens National Health System, Washington, DC, USA
Background: The accuracy of clinical examination is limited for early diagnosis of Rheumatic Heart Disease (RHD). The 2012 World Heart Federation (WHF) Criteria provides standardized echocardiographic (echo) guidelines for diagnosis of RHD. There is sparse data on echo prevalence of RHD in Brazil. Objective: Assess the prevalence of RHD in students (6-18 years) from public schools in low-income areas in Brazil.
Methods: Over 13 months, non-physicians and experts used standard portable (GE, Vivid-Q) or handheld machines (GE, VSCAN) and the 2012 WHF Criteria to determine RHD prevalence. All consented and present children were eligible for participation. All studies were officially interpreted remotely using a telemedicine cloud-server by experts in Brazil and the US. RHD prevalence by gender, age (5-11 & 12-18) and region of the state (central or north) were compared using Fisher’s Exact Test.
Results: A total of 4,400 students were screened across 17 schools in urban and rural areas of Minas Gerais, Brazil. The mean age was 13.6±2.8 (6 to 18) years, 52.3% female. The prevalence of RHD was 5.1% (226/4400): 4.6% borderline RHD (n=205) and 0.5% definite RHD (n=21). Of these, 83.7% had pathologic mitral regurgitation and 27 (16.3%) had pathologic aortic regurgitation. Ten children had mixed mitral/aortic valve disease and 1 had mitral stenosis. There was no difference in RHD prevalence between younger and older kids (p=0.49) or between northern (predominantly rural) and central areas (5.9% vs. 5.0%, p=0.46). Girls had higher prevalence (5.9% vs. 4.1%, p=0.009). Minor congenital heart disease was detected in 35 additional children (0.8%), including 11 mitral prolapses and 4 ASDs. Kids with abnormal results were referred for follow-up echo. Conclusions: WHF Criteria make it possible to obtain and accurately compare echo prevalence of RHD among different regions of the world. The PROVAR study shows that, among children living in low-socioeconomic conditions in Brazil, RHD remains a significant health burden, comparable to that in other low-resource communities. Contemporary data such as these provide justification for investing in comprehensive RHD control programs in Brazil, and around the globe.
Non Invasive Imaging (Echocardiography, Nuclear, PET, MR and CT) RHEUMATIC HEART DISEASE SCREENING IN SCHOOLS THROUGH PORTABLE ECHOCARDIOGRAPHY IN BRAZIL: DATA FROM THE PROVAR STUDY Moderated Poster Contributions Non Invasive Imaging Moderated Poster Theater, Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-9:55 a.m. Session Title: Advances in Echocardiography Abstract Category: 29. Non Invasive Imaging: Echo Presentation Number: 1199M-01 Authors: Bruno Ramos Nascimento, Andrea Beaton, Maria do Carmo Nunes, Adriana Diamantino, Kaciane K. Oliveira, Cassio M. Oliveira, Vitoria M. Rezende, Eduardo L. Lopes, Amanda O. Lauar, Luise C. Barros, Michelle C. Galbas, Lindsay Perlman, Antonio Ribeiro, Craig Sable, Hospital das Cinicas da Univeresidade Federal de Minas Gerais, Belo Horizonte, Brazil, Childrens National Health System, Washington, DC, USA
Background: The accuracy of clinical examination is limited for early diagnosis of Rheumatic Heart Disease (RHD). The 2012 World Heart Federation (WHF) Criteria provides standardized echocardiographic (echo) guidelines for diagnosis of RHD. There is sparse data on echo prevalence of RHD in Brazil. Objective: Assess the prevalence of RHD in students (6-18 years) from public schools in low-income areas in Brazil.
Methods: Over 13 months, non-physicians and experts used standard portable (GE, Vivid-Q) or handheld machines (GE, VSCAN) and the 2012 WHF Criteria to determine RHD prevalence. All consented and present children were eligible for participation. All studies were officially interpreted remotely using a telemedicine cloud-server by experts in Brazil and the US. RHD prevalence by gender, age (5-11 & 12-18) and region of the state (central or north) were compared using Fisher’s Exact Test.
Results: A total of 4,400 students were screened across 17 schools in urban and rural areas of Minas Gerais, Brazil. The mean age was 13.6±2.8 (6 to 18) years, 52.3% female. The prevalence of RHD was 5.1% (226/4400): 4.6% borderline RHD (n=205) and 0.5% definite RHD (n=21). Of these, 83.7% had pathologic mitral regurgitation and 27 (16.3%) had pathologic aortic regurgitation. Ten children had mixed mitral/aortic valve disease and 1 had mitral stenosis. There was no difference in RHD prevalence between younger and older kids (p=0.49) or between northern (predominantly rural) and central areas (5.9% vs. 5.0%, p=0.46). Girls had higher prevalence (5.9% vs. 4.1%, p=0.009). Minor congenital heart disease was detected in 35 additional children (0.8%), including 11 mitral prolapses and 4 ASDs. Kids with abnormal results were referred for follow-up echo. Conclusions: WHF Criteria make it possible to obtain and accurately compare echo prevalence of RHD among different regions of the world. The PROVAR study shows that, among children living in low-socioeconomic conditions in Brazil, RHD remains a significant health burden, comparable to that in other low-resource communities. Contemporary data such as these provide justification for investing in comprehensive RHD control programs in Brazil, and around the globe.