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Prevalence of Rheumatic Heart Disease in Cambodia and Mozambique

Echocardiography revealed a much higher prevalence than did clinical examination.

Reported prevalence of rheumatic heart disease in countries where it is common is based on clinical screening, which is less sensitive than echocardiography in the detection of valvular abnormalities. To determine the true prevalence of rheumatic heart disease, and to compare rates based on echocardiographic evidence with those based on clinical criteria, investigators conducted population-based studies of schoolchildren in Cambodia and Mozambique. The authors hypothesized that the use of echocardiography would demonstrate twice as many cases as might be expected from published estimates.

In Cambodia, 3677 children (mean age, 12 years) were examined. Rheumatic heart disease was identified in 8 children by clinical criteria and in 79 by echocardiography. Prevalence based on clinical criteria was 2.2 cases per 1000 children, and prevalence based on echocardiography was 21.5 per 1000.

In Mozambique, 2170 children (mean age, 11 years) were examined. Rheumatic heart disease was identified in 5 children by clinical criteria and in 66 by echocardiography. Prevalence based on clinical criteria was 2.3 cases per 1000 children, and prevalence based on echocardiography was 30.4 per 1000. Clinical examination provoked suspicion of organic valvular abnormalities in 91 children, but echocardiography revealed cardiac lesions in only 10.

Comment: These findings confirm that the prevalence of rheumatic heart disease in at least two developing countries is considerably underestimated by applying clinical criteria alone. Given that rheumatic heart disease was clinically silent in a high percentage of the children in which it was found, screening strategies that employ echocardiography seem to be necessary to mitigate the potential consequences of the disease. The challenges we face are solving the problem of scarce resources and determining the best approaches to screening and secondary prevention in these populations.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology August 1, 2007

Citation(s):

Marijon E et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007 Aug 2; 357:470-6.

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