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Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren
OBJECTIVES: Echocardiographic (echo) screening is an important tool to estimate rheumatic heart disease (RHD) prevalence, but the natural history of screen-detected RHD remains unclear. The PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática) study, which uses non-experts, telemedicine and por...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223287/ https://www.ncbi.nlm.nih.gov/pubmed/32393615 http://dx.doi.org/10.1136/bmjopen-2020-036827 |
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author | Bechtlufft, Bárbara Martins Nascimento, Bruno Ramos Sable, Craig Fraga, Clara Leal Barbosa, Márcia Melo Reis, Susana Drumond Diamantino, Adriana Costa Meira, Zilda Maria Alves Castilho, Sandra Regina Tolentino Arantes, Nayana Flamini Oliveira, Kaciane Krauss Silva, José Luiz Padilha Rezende, Breno De Filippo Costa, Waydder Antônio Aurélio Mata, Mariana Duarte Pereira, Augusto Ferreira Ribeiro, Antonio Luiz Pinho Beaton, Andrea Zawacki Pereira Nunes, Maria Carmo |
author_facet | Bechtlufft, Bárbara Martins Nascimento, Bruno Ramos Sable, Craig Fraga, Clara Leal Barbosa, Márcia Melo Reis, Susana Drumond Diamantino, Adriana Costa Meira, Zilda Maria Alves Castilho, Sandra Regina Tolentino Arantes, Nayana Flamini Oliveira, Kaciane Krauss Silva, José Luiz Padilha Rezende, Breno De Filippo Costa, Waydder Antônio Aurélio Mata, Mariana Duarte Pereira, Augusto Ferreira Ribeiro, Antonio Luiz Pinho Beaton, Andrea Zawacki Pereira Nunes, Maria Carmo |
author_sort | Bechtlufft, Bárbara Martins |
collection | PubMed |
description | OBJECTIVES: Echocardiographic (echo) screening is an important tool to estimate rheumatic heart disease (RHD) prevalence, but the natural history of screen-detected RHD remains unclear. The PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática) study, which uses non-experts, telemedicine and portable echo, pioneered RHD screening in Brazil. We aimed to assess the mid-term evolution of Brazilian schoolchildren (5–18 years) with echocardiography-detected subclinical RHD and to assess the performance of a simplified score consisting of five components of the World Heart Federation criteria, as a predictor of unfavourable echo outcomes. SETTING: Public schools of underserved areas and private schools in Minas Gerais, southeast Brazil. PARTICIPANTS: A total of 197 patients (170 borderline and 27 definite RHD) with follow-up of 29±9 months were included. Median age was 14 (12–16) years, and 130 (66%) were woman. Only four patients in the definite group were regularly receiving penicillin. PRIMARY AND SECONDARY OUTCOME MEASURES: Unfavourable outcome was based on the 2-year follow-up echo, defined as worsening diagnostic category, remaining with mild definite RHD or development/worsening of valve regurgitation/stenosis. RESULTS: Among patients with borderline RHD, 29 (17.1%) progressed to definite, 49 (28.8%) remained stable, 86 (50.6%) regressed to normal and 6 (3.5%) were reclassified as other heart diseases. Among those with definite RHD, 13 (48.1%) remained in the category, while 5 (18.5%) regressed to borderline, 5 (18.5%) regressed to normal and 4 (14.8%) were reclassified as other heart diseases. The simplified echo score was a significant predictor of RHD unfavourable outcome (HR 1.197, 95% CI 1.098 to 1.305, p<0.001). CONCLUSION: The simple risk score provided an accurate prediction of RHD status at 2-year follow-up, showing a good performance in Brazilian schoolchildren, with a potential value for risk stratification and monitoring of echocardiography-detected RHD. |
format | Online Article Text |
id | pubmed-7223287 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-72232872020-05-15 Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren Bechtlufft, Bárbara Martins Nascimento, Bruno Ramos Sable, Craig Fraga, Clara Leal Barbosa, Márcia Melo Reis, Susana Drumond Diamantino, Adriana Costa Meira, Zilda Maria Alves Castilho, Sandra Regina Tolentino Arantes, Nayana Flamini Oliveira, Kaciane Krauss Silva, José Luiz Padilha Rezende, Breno De Filippo Costa, Waydder Antônio Aurélio Mata, Mariana Duarte Pereira, Augusto Ferreira Ribeiro, Antonio Luiz Pinho Beaton, Andrea Zawacki Pereira Nunes, Maria Carmo BMJ Open Cardiovascular Medicine OBJECTIVES: Echocardiographic (echo) screening is an important tool to estimate rheumatic heart disease (RHD) prevalence, but the natural history of screen-detected RHD remains unclear. The PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática) study, which uses non-experts, telemedicine and portable echo, pioneered RHD screening in Brazil. We aimed to assess the mid-term evolution of Brazilian schoolchildren (5–18 years) with echocardiography-detected subclinical RHD and to assess the performance of a simplified score consisting of five components of the World Heart Federation criteria, as a predictor of unfavourable echo outcomes. SETTING: Public schools of underserved areas and private schools in Minas Gerais, southeast Brazil. PARTICIPANTS: A total of 197 patients (170 borderline and 27 definite RHD) with follow-up of 29±9 months were included. Median age was 14 (12–16) years, and 130 (66%) were woman. Only four patients in the definite group were regularly receiving penicillin. PRIMARY AND SECONDARY OUTCOME MEASURES: Unfavourable outcome was based on the 2-year follow-up echo, defined as worsening diagnostic category, remaining with mild definite RHD or development/worsening of valve regurgitation/stenosis. RESULTS: Among patients with borderline RHD, 29 (17.1%) progressed to definite, 49 (28.8%) remained stable, 86 (50.6%) regressed to normal and 6 (3.5%) were reclassified as other heart diseases. Among those with definite RHD, 13 (48.1%) remained in the category, while 5 (18.5%) regressed to borderline, 5 (18.5%) regressed to normal and 4 (14.8%) were reclassified as other heart diseases. The simplified echo score was a significant predictor of RHD unfavourable outcome (HR 1.197, 95% CI 1.098 to 1.305, p<0.001). CONCLUSION: The simple risk score provided an accurate prediction of RHD status at 2-year follow-up, showing a good performance in Brazilian schoolchildren, with a potential value for risk stratification and monitoring of echocardiography-detected RHD. BMJ Publishing Group 2020-05-10 /pmc/articles/PMC7223287/ /pubmed/32393615 http://dx.doi.org/10.1136/bmjopen-2020-036827 Text en © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Cardiovascular Medicine Bechtlufft, Bárbara Martins Nascimento, Bruno Ramos Sable, Craig Fraga, Clara Leal Barbosa, Márcia Melo Reis, Susana Drumond Diamantino, Adriana Costa Meira, Zilda Maria Alves Castilho, Sandra Regina Tolentino Arantes, Nayana Flamini Oliveira, Kaciane Krauss Silva, José Luiz Padilha Rezende, Breno De Filippo Costa, Waydder Antônio Aurélio Mata, Mariana Duarte Pereira, Augusto Ferreira Ribeiro, Antonio Luiz Pinho Beaton, Andrea Zawacki Pereira Nunes, Maria Carmo Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren |
title | Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren |
title_full | Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren |
title_fullStr | Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren |
title_full_unstemmed | Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren |
title_short | Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren |
title_sort | validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of brazilian schoolchildren |
topic | Cardiovascular Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223287/ https://www.ncbi.nlm.nih.gov/pubmed/32393615 http://dx.doi.org/10.1136/bmjopen-2020-036827 |
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