Outcomes of latent rheumatic heart disease: External validation of a simplified score in patients with and without secondary prophylaxis.

Autor: Nascimento BR; Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil; Serviço de Hemodinâmica, Hospital Madre Teresa, Belo Horizonte, MG, Brazil. Electronic address: ramosnas@gmail.com., Nunes MCP; Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil., da Silva JLP; Departamento de Estatística, Universidade Federal do Paraná, Curitiba, PR, Brazil., Steer A; Emory University School of Medicine, Atlanta, GA, USA., Engelman D; Melbourne Children's Global Health, Royal Children's Hospital, Melbourne, Australia, and Telethon Kids Institute, Perth Children's Hospital, University of Western Australia, Perth, Australia., Okello E; Uganda Heart Institute and the Department of Medicine, Makerere University, Kampala, Uganda., Rwebembera J; Uganda Heart Institute and the Department of Medicine, Makerere University, Kampala, Uganda., Zuhlke L; South African Medical Research Council, Parow Cape Town, Division of Paediatric Cardiology, Department of Paediatrics, Red Cross War Memorial Children's Hospital, Cape Town, South Africa., Mirabel M; Institut Mutualiste Montsouris, Paris, France., Nakitto M; Uganda Heart Institute and the Department of Medicine, Makerere University, Kampala, Uganda., Sarnacki R; Cardiology, Children's National Hospital, Washington, DC, USA., Ribeiro ALP; Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil., Sable CA; Cardiology, Children's National Hospital, Washington, DC, USA., Beaton AZ; The Heart Institute, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati School of Medicine, Cincinnati, OH, USA.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2024 Mar 15; Vol. 399, pp. 131662. Date of Electronic Publication: 2023 Dec 22.
DOI: 10.1016/j.ijcard.2023.131662
Abstrakt: Background: Secondary antibiotic prophylaxis reduces progression of latent rheumatic heart disease (RHD) but not all children benefit. Improved risk stratification could refine recommendations following positive screening. We aimed to evaluate the performance of a previously developed echocardiographic risk score to predict mid-term outcomes among children with latent RHD.
Methods: We included children who completed the GOAL, a randomized trial of secondary antibiotic prophylaxis among children with latent RHD in Uganda. Outcomes were determined by a 4-member adjudication panel. We applied the point-based score, consisting of 5 variables (mitral valve (MV) anterior leaflet thickening (3 points), MV excessive leaflet tip motion (3 points), MV regurgitation jet length ≥ 2 cm (6 points), aortic valve focal thickening (4 points) and any aortic regurgitation (5 points)), to panel results. Unfavorable outcome was defined as progression of diagnostic category (borderline to definite, mild definite to moderate/severe definite), worsening valve involvement or remaining with mild definite RHD.
Results: 799 patients (625 borderline and 174 definite RHD) were included, with median follow-up of 24 months. At total 116 patients (14.5%) had unfavorable outcome per study criteria, 57.8% not under prophylaxis. The score was strongly associated with unfavorable outcome (HR = 1.26, 95% CI 1.16-1.37, p < 0.001). Unfavorable outcome rates in low (≤6 points), intermediate (7-9 points) and high-risk (≥10 points) children at follow-up were 11.8%, 30.4%, and 42.2%, (p < 0.001) respectively (C-statistic = 0.64 (95% CI 0.59-0.69)).
Conclusions: The simple risk score provided an accurate prediction of RHD status at 2-years, showing a good performance in a population with milder RHD phenotypes.
Competing Interests: Declaration of Competing Interest The authors of the manuscript have no relevant conflicts of interest to disclose regarding this study.
(Copyright © 2023 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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