title: Echocardiography screening to detect rheumatic heart disease: A cohort study of schoolchildren in French Pacific Islands.
abstract: OBJECTIVE
  The objective of this study is to assess the outcomes of rheumatic heart disease (RHD) diagnosed by means of echocardiography-based screening.
  
  
  METHODS
  A cohort of children with and with no RHD was driven from a systematic echocardiography-based nationwide surveillance among 4th grade (age 9-10 years) schoolchildren in South-Pacific New Caledonia (2008-2011). The specific follow-up programme used clinical and standardised echocardiography (2012 World Heart Federation criteria) predefined endpoints.
  
  
  RESULTS
  Out of the 17,633 children screened, 157 were detected with findings of RHD. Among them, 114 consented children (76.5%) were enrolled (RHD-group), and were compared to 227 randomly selected healthy classmates (non-RHD group). After a median follow-up period of 2.58 years [1.31-3.63], incidence of acute rheumatic fever was similar in RHD and non-RHD groups (p=0.23): 10.28/1000/year and 3.31/1000/year, respectively. By echocardiography, 90 children in the RHD group (78.9%) still presented with RHD at follow-up, compared to 31 (13.7%) in the non-RHD group (p<0.0001). Only 12 children (10.5%) experienced progression of RHD over time, mild single valve disease lesions remaining unchanged in the majority of cases (61 out of 73, 83.6%). Overcrowded living conditions were independently associated with persistent RHD on echocardiography (OR 8.27 95% CI (1.67-41.08), p<0.01). Benzathine penicillin G was given in 88.6% of children in the RHD-group.
  
  
  CONCLUSIONS
  Children screened positive for RHD by echocardiography have mostly mild but irreversible heart valve disease under secondary prophylaxis. Our findings also suggest that a single screening point in childhood may prove insufficient in high-risk populations.
authors.affiliation: INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Cardiology & Development, Paris, France. Electronic address: mariana.mirabel@inserm.fr.
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
authors.affiliation: INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France; Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fauchier
authors.affiliation: INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France.
authors.forename: Raoul
authors.initials: R
authors.lastname: Bacquelin
authors.affiliation: INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.affiliation: Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie.
authors.forename: Agnès
authors.initials: A
authors.lastname: Germain
authors.affiliation: Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie.
authors.forename: Corinne
authors.initials: C
authors.lastname: Robillard
authors.affiliation: Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie.
authors.forename: Bernard
authors.initials: B
authors.lastname: Rouchon
authors.affiliation: INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Cardiology & Development, Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France; Cardiology & Development, Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
mesh_terms: D017677:Age Distribution; D002648:Child; D015331:Cohort Studies; D016001:Confidence Intervals; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000379:methods*; D009510:New Caledonia / Q000453:epidemiology; D016017:Odds Ratio; D012213:Rheumatic Fever / Q000000981:diagnostic imaging / Q000453:epidemiology; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D018570:Risk Assessment; D017678:Sex Distribution; D018709:Statistics, Nonparametric; D013334:Students / Q000706:statistics & numerical data
keywords: Acute rheumatic fever; Global health; Heart valve disease; Rheumatic heart disease; Ultrasounds