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Latent rheumatic heart disease: outcomes 2 years after echocardiographic detection.
[acute rheumatic fever]
Screening
with
portable
echocardiography
has
uncovered
a
large
burden
of
latent
rheumatic
heart
disease
(
RHD
)
among
asymptomatic
children
in
endemic
regions
,
the
significance
of
which
remains
unclear
.
This
study
aimed
to
determine
the
2
-
year
outcomes
for
children
with
latent
RHD
diagnosed
by
echocardiographic
screening
.
Children
identified
with
latent
RHD
enrolled
in
a
biannual
follow-up
program
.
Risk
factors
for
disease
persistence
and
progression
were
examined
.
Of
62
children
,
51
(
82
%
)
with
latent
RHD
had
a
median
follow-up
period
of
25
months
.
Of
these
51
children
,
17
(
33
.
3
%
)
reported
an
interval
sore
throat
or
symptoms
consistent
with
acute
rheumatic
fever
(
ARF
)
.
Of
43
children
initially
classified
as
having
borderline
RHD
,
21
(
49
%
)
remained
stable
,
18
(
42
%
)
improved
(
to
no
RHD
)
and
4
(
10
%
)
worsened
to
definite
RHD
.
Of
the
8
children
initially
classified
as
having
definite
RHD
,
6
(
75
%
)
remained
stable
,
and
2
(
25
%
)
improved
to
borderline
RHD
.
Two
children
had
confirmed
episodes
of
recurrent
ARF
,
one
of
which
represented
the
sole
case
of
clinical
worsening
.
The
risk
factors
for
disease
persistence
or
progression
included
younger
age
(
p
=
0
.
05
)
,
higher
antistreptolysin
O
titers
at
diagnosis
(
p
=
0
.
05
)
,
and
more
morphologic
valve
abnormalities
(
p
=
0
.
01
)
.
After
2
years
,
most
of
the
children
had
a
benign
course
,
with
91
%
remaining
stable
or
showing
improvement
.
Education
may
improve
recognition
of
streptococcal
sore
throat
.
Longer-term
follow-up
evaluation
,
however
,
is
warranted
to
confirm
disease
progression
and
risk
factor
profile
.
This
could
help
tailor
screening
protocols
for
those
at
highest
risk
.
Diseases
Validation
Diseases presenting
"factor profile"
symptom
acute rheumatic fever
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