Cargando…

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...

Descripción completa

Detalles Bibliográficos
Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2020
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
_version_ 1783533729804713984
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
work_keys_str_mv AT bechtlufftbarbaramartins validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT nascimentobrunoramos validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT sablecraig validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT fragaclaraleal validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT barbosamarciamelo validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT reissusanadrumond validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT diamantinoadrianacosta validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT meirazildamariaalves validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT castilhosandrareginatolentino validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT arantesnayanaflamini validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT oliveirakacianekrauss validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT silvajoseluizpadilha validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT rezendebrenodefilippo validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT costawaydderantonioaurelio validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT matamarianaduarte validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT pereiraaugustoferreira validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT ribeiroantonioluizpinho validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT beatonandreazawacki validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren
AT pereiranunesmariacarmo validationofasimplifiedscoreforpredictinglatentrheumaticheartdiseaseprogressionusingaprospectivecohortofbrazilianschoolchildren