title: Echocardiographic prevalence of rheumatic heart disease in Brazilian schoolchildren: Data from the PROVAR study.
abstract: BACKGROUND
  Accurate estimates of Rheumatic Heart Disease (RHD) burden are needed to justify improved integration of RHD prevention and screening into the public health systems, but data from Latin America are still sparse.
  
  
  OBJECTIVE
  To determine the prevalence of RHD among socioeconomically disadvantaged youth (5-18years) in Brazil and examine risk factors for the disease.
  
  
  METHODS
  The PROVAR program utilizes non-expert screeners, telemedicine, and handheld and standard portable echocardiography to conduct echocardiographic screening in socioeconomically disadvantaged schools in Minas Gerais, Brazil. Cardiologists in the US and Brazil provide expert interpretation according to the 2012 World Heart Federation Guidelines. Here we report prevalence data from the first 14months of screening, and examine risk factors for RHD.
  
  
  RESULTS
  5996 students were screened across 21 schools. Median age was 11.9 [9.0/15.0] years, 59% females. RHD prevalence was 42/1000 (n=251): 37/1000 borderline (n=221) and 5/1000 definite (n=30). Pathologic mitral regurgitation was observed in 203 (80.9%), pathologic aortic regurgitation in 38 (15.1%), and mixed mitral/aortic valve disease in 10 (4.0%) children. Older children had higher prevalence (50/1000 vs. 28/1000, p<0.001), but no difference was observed between northern (lower resourced) and central areas (34/1000 vs. 44/1000, p=0.31). Females had higher prevalence (48/1000 vs. 35/1000, p=0.016). Age (OR=1.15, 95% CI:1.10-1.21, p<0.001) was the only variable independently associated with RHD findings.
  
  
  CONCLUSIONS
  RHD continues to be an important and under recognized condition among socioeconomically disadvantaged Brazilian schoolchildren. Our data adds to the compelling case for renewed investment in RHD prevention and early detection in Latin America.
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil. Electronic address: ramosnas@gmail.com.
authors.forename: Bruno R
authors.initials: BR
authors.lastname: Nascimento
authors.affiliation: Children's National Health System, Washington, DC, United States.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: Beaton
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Maria Carmo P
authors.initials: MC
authors.lastname: Nunes
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil.
authors.forename: Adriana C
authors.initials: AC
authors.lastname: Diamantino
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Gabriel A L
authors.initials: GA
authors.lastname: Carmo
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil.
authors.forename: Kaciane K B
authors.initials: KK
authors.lastname: Oliveira
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil.
authors.forename: Cassio M
authors.initials: CM
authors.lastname: Oliveira
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Zilda Maria A
authors.initials: ZM
authors.lastname: Meira
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Sandra Regina T
authors.initials: SR
authors.lastname: Castilho
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Eduardo L V
authors.initials: EL
authors.lastname: Lopes
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Iara M
authors.initials: IM
authors.lastname: Castro
authors.affiliation: Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Vitória M L R
authors.initials: VM
authors.lastname: Rezende
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Graziela
authors.initials: G
authors.lastname: Chequer
authors.affiliation: Children's National Health System, Washington, DC, United States.
authors.forename: Taylor
authors.initials: T
authors.lastname: Landay
authors.affiliation: Children's National Health System, Washington, DC, United States.
authors.forename: Allison
authors.initials: A
authors.lastname: Tompsett
authors.affiliation: Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da UFMG, Belo Horizonte, MG, Brazil; Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Antônio Luiz P
authors.initials: AL
authors.lastname: Ribeiro
authors.affiliation: Children's National Health System, Washington, DC, United States.
authors.forename: Craig
authors.initials: C
authors.lastname: Sable
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000191:economics* / Q000639:trends; D005260:Female; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology; D012923:Social Class; D013334:Students; D017216:Telemedicine / Q000191:economics / Q000639:trends; D035862:Vulnerable Populations
keywords: Echocardiography; Rheumatic heart disease; Screening; Telemedicine