Zimmerman Meghan, Scheel Amy, DeWyer Alyssa, Nambogo Jane-Liz, Otim Isaac Omara, Tompsett Alison, Rwebembera Joselyn, Okello Emmy, Sable Craig, Beaton Andrea
Children's Hospital at Dartmouth Hitchcock, Lebanon, PA, United States.
Dartmouth College, Hanover, IN, United States.
Front Cardiovasc Med. 2021 Feb 12;8:632621. doi: 10.3389/fcvm.2021.632621. eCollection 2021.
Screening echocardiograms can detect early-stage rheumatic heart disease (RHD), offering a chance to limit progression. Implementation of screening programs is challenging and requires further research. This is the first large-scale study assessing the risk of RHD among previous screen-negative children. This retrospective cohort study, conducted in Gulu, Uganda, performed school-based echo screening on children ages 5-18 years. Surveys were used to determine which children underwent initial screening 3-5 years prior. Age, gender, and disease severity were compared between cohorts. Relative risk (RR) of RHD was calculated for those with a prior screen-negative echo (exposed cohort) compared to those undergoing first screening (unexposed cohort). Echo screening was completed in 75,708 children; 226 were excluded, leaving 1,582 in the exposed cohort and 73,900 in the unexposed cohort. Prevalence of new RHD was 0.6% (10/1,582) and 1% (737/73,900), in the exposed and unexposed cohorts, respectively. The RR of RHD was 0.64 (95% CI 0.3-1.2, = 0.15), a nearly 40% reduced risk of RHD in those with a prior negative echo. There was no difference in age or gender between RHD cohorts. All cases in the exposed cohort were borderline/mild; 2.6% of cases in the unexposed cohort had moderate/severe disease. There was no statistical difference in RHD prevalence between previous screen-negative children and children with no prior echocardiogram, however, there was a trend toward decreased risk and severity. This information has important implications for the design of screening programs and the use of screening echocardiograms in endemic RHD regions.
筛查超声心动图可检测早期风湿性心脏病（RHD），为限制病情进展提供机会。实施筛查项目具有挑战性，需要进一步研究。这是第一项评估既往筛查阴性儿童患RHD风险的大规模研究。这项回顾性队列研究在乌干达古卢进行，对5至18岁儿童进行了基于学校的超声筛查。通过调查确定哪些儿童在3至5年前接受了初次筛查。对队列之间的年龄、性别和疾病严重程度进行了比较。计算了既往筛查阴性超声心动图的儿童（暴露队列）与首次筛查的儿童（未暴露队列）患RHD的相对风险（RR）。75708名儿童完成了超声筛查；226名被排除，暴露队列中留下1582名，未暴露队列中留下73900名。暴露队列和未暴露队列中新发RHD的患病率分别为0.6%（10/1582）和1%（737/73900）。RHD的RR为0.64（95%CI 0.3 - 1.2，P = 0.15），既往超声心动图阴性的儿童患RHD的风险降低了近40%。RHD队列之间在年龄或性别上没有差异。暴露队列中的所有病例均为临界/轻度；未暴露队列中2.6%的病例患有中度/重度疾病。既往筛查阴性儿童与未进行过超声心动图检查的儿童之间的RHD患病率没有统计学差异，然而，存在风险和严重程度降低的趋势。这些信息对地方性RHD地区筛查项目的设计以及筛查超声心动图的使用具有重要意义。
