title: Outcomes of borderline rheumatic heart disease: A prospective cohort study.
abstract: OBJECTIVE
  The advent of systematic screening for rheumatic heart disease (RHD) by echocardiography in endemic regions has led to a new entity: borderline RHD. The pathogenicity and natural history of borderline RHD needs to be addressed. The aim of this study was to assess the outcomes of children detected by echocardiography as having borderline RHD.
  
  
  METHODS
  Schoolchildren in 4th grade (i.e., aged 9-10years) who were prospectively echo-screened for RHD (2012-2014) in Nouméa, New Caledonia, were asked to participate. Children with borderline RHD according to consistent independent review by two cardiologists were included and followed-up in 2015.
  
  
  RESULTS
  Among the 8684 schoolchildren screened, 49 were diagnosed with borderline RHD according to the Cardiologist clinically involved in the child's management plan. After independent review by two cardiologists, 25 children were consistently diagnosed with borderline RHD and included in the follow-up study. Overall, inter-observer agreement was moderate with diagnostic kappa values of 0.63 (95% CI 0.45-0.78). After a median follow-up of 23months (IQR (20.5-33.0), 15 children (60.0%) had stability of valvular lesions, 8 (32.0%) had normal findings according to the WHF criteria. Two children (8.0%) had definite RHD on the follow-up echocardiogram, but no clinical events or audible pathological murmur during the study period. No factor could be identified as prognostic of either stability or progression.
  
  
  CONCLUSIONS
  Borderline RHD diagnosed by systematic screening in high-risk populations remains mostly unchanged at 2years follow-up. Diagnosis of borderline RHD may require two reviewers for consistency.
authors.affiliation: INSERMU970, Paris Cardiovascular Research Centre-PARCC, Paris, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Bertaina
authors.affiliation: Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie.
authors.forename: Bernard
authors.initials: B
authors.lastname: Rouchon
authors.affiliation: Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Huon
authors.affiliation: Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie.
authors.forename: Nina
authors.initials: N
authors.lastname: Guillot
authors.affiliation: Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie.
authors.forename: Corinne
authors.initials: C
authors.lastname: Robillard
authors.affiliation: Centre Hospitalier Territorial, Nouméa, Nouvelle-Calédonie.
authors.forename: Baptiste
authors.initials: B
authors.lastname: Noël
authors.affiliation: Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, Nouvelle-Calédonie; Centre Hospitalier Territorial, Nouméa, Nouvelle-Calédonie.
authors.forename: Marie
authors.initials: M
authors.lastname: Nadra
authors.affiliation: Department of Cardiology, University Hospital Amiens, Amiens, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Tribouilloy
authors.affiliation: INSERMU970, 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.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.affiliation: INSERMU970, 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.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.affiliation: INSERMU970, 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. Electronic address: mariana.mirabel@inserm.fr.
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
mesh_terms: D002648:Child; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015588:Observer Variation; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy
keywords: Adolescent health; Echocardiography; Heart valve disease; Rheumatic heart disease