Atalay Semra, Tutar Ercan, Uçar Tayfun, Topçu Seda, Köse Serdal K, Doğan Melih T
Division of Pediatrics Cardiology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
Division of Social Pediatrics, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
Cardiol Young. 2019 Oct;29(10):1272-1277. doi: 10.1017/S1047951119002075. Epub 2019 Sep 2.
The aim of this study is to investigate the prevalence of subclinical rheumatic heart disease in schoolchildren aged 5-18 by using portable echocardiography in Ankara, Turkey.
The portable echocardiography screening was performed by a paediatric cardiologist for all of the cases. The mean age of 2550 healthy students was 11.09 ± 2.91 years (1339 females, 1211 males) in three private and three public schools. Echocardiographic studies were assessed according to 2012 World Heart Federation criteria for rheumatic heart disease.
After reviewing the echocardiographic images, 73 students were reevaluated by an advanced echocardiography device in the university hospital. Evidence of definite subclinical rheumatic heart disease was found in 39 students (15/1000) and borderline rheumatic heart disease in 20 students (8/1000). No children had any clinical symptoms. The mean age of children diagnosed with rheumatic heart disease and borderline rheumatic heart disease is 12.4 and 11.4 years, respectively. The risk of rheumatic heart disease was found to be increased sevenfold in girls between 14 and 18 years. We surprisingly observed that the prevalence of definite rheumatic heart disease in private schools located in high-income areas of Ankara was higher than that in public schools.
This is the first and largest single-centred echocardiographic screening study for subclinical rheumatic heart disease in Turkish schoolchildren. The frequency of rheumatic heart disease has been found to be 15/1000. This finding is similar to those of recent echocardiographic screening studies performed in middle and high-risk populations. We conclude that to decrease the burden of rheumatic heart disease, echocardiographic screening studies are necessary, and long-term follow-up of children with echocardiographically diagnosed subclinical rheumatic heart disease is needed.
本研究旨在通过便携式超声心动图检查，调查土耳其安卡拉5至18岁学龄儿童亚临床风湿性心脏病的患病率。
所有病例均由儿科心脏病专家进行便携式超声心动图筛查。在三所私立学校和三所公立学校中，2550名健康学生的平均年龄为11.09±2.91岁（女生1339名，男生1211名）。根据2012年世界心脏联合会风湿性心脏病标准对超声心动图研究进行评估。
在审查超声心动图图像后，73名学生在大学医院通过先进的超声心动图设备进行了重新评估。在39名学生（15/1000）中发现了明确的亚临床风湿性心脏病证据，在20名学生（8/1000）中发现了临界风湿性心脏病证据。没有儿童有任何临床症状。被诊断为风湿性心脏病和临界风湿性心脏病的儿童平均年龄分别为12.4岁和11.4岁。发现14至18岁女孩患风湿性心脏病的风险增加了7倍。我们惊讶地观察到，位于安卡拉高收入地区的私立学校中明确风湿性心脏病的患病率高于公立学校。
这是首次针对土耳其学龄儿童亚临床风湿性心脏病进行的最大规模单中心超声心动图筛查研究。已发现风湿性心脏病的发病率为15/1000。这一发现与近期在中高风险人群中进行的超声心动图筛查研究结果相似。我们得出结论，为减轻风湿性心脏病负担，有必要进行超声心动图筛查研究，并且需要对超声心动图诊断为亚临床风湿性心脏病的儿童进行长期随访。
