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Echocardiographic screening for rheumatic heart disease: age matters.
[acute rheumatic fever]
Echocardiography
is
emerging
as
a
screening
tool
for
rheumatic
heart
disease
(
RHD
)
in
endemic
regions
.
The
vast
majority
of
surveys
have
been
limited
to
children
.
We
ought
to
appreciate
the
interest
of
including
adolescents
in
their
late
teens
in
such
school
screening
programmes
.
School
-based
echocardiography
cross-sectional
survey
conducted
in
Dakar
,
Senegal
(
March
2010
)
.
A
total
of
2004
school
attendees
were
randomly
selected
and
enrolled
in
the
study
,
among
which
1116
were
aged
5
-
15
years
old
(
group
1
)
,
and
888
were
16
-
18
years
old
(
group
2
)
.
Case
detection
rates
and
phenotype
of
RHD
were
compared
according
to
age
groups
.
A
total
of
22
youngsters
were
suspected
by
on-site
echocardiography
,
12
in
group
1
and
10
in
group
2
.
Among
the
12
RHD
cases
suspected
on-site
in
group
1
,
6
(
50
%
)
were
eventually
considered
as
confirmed
RHD
,
compared
to
9
out
of
10
(
90
%
)
in
group
2
,
giving
prevalence
rates
of
5
.
4
(
CI
95
%
2
.
0
-
11
.
7
)
and
10
.
1
(
CI
95
%
4
.
6
-
19
.
2
)
per
1000
in
group
1
and
group
2
,
respectively
.
The
proportion
of
marked
/
advanced
lesions
was
33
%
in
group
1
,
and
89
%
in
group
2
(
p
=
0
.
08
)
.
Mean
concordance
rates
between
the
3
reviewers
were
40
%
for
group
1
,
compared
to
93
%
in
group
2
(
p
=
0
.
05
)
.
Extension
of
screening
to
adolescents
in
their
late
teens
should
be
considered
with
interest
in
the
light
of
the
higher
prevalence
of
the
disease
and
relative
clarity
of
subclinical
cardiac
lesions
that
could
be
more
easily
detected
in
the
field
.
Diseases
Validation
Diseases presenting
"subclinical cardiac lesions"
symptom
acute rheumatic fever
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