TY  - EJOU
AU  - Sanyahumbi, Amy 
AU  - Andrea Beaton, 
AU  - Danielle Guffey, 
AU  - Hosseinipour, Mina C. 
AU  - Melissa Karlsten, 
AU  - G. Minard, Charles 
AU  - Penny, Daniel J. 
AU  - A. Sable, Craig 
AU  - N. Kazembe, Peter 

TI  - Two‐year evolution of latent rheumatic heart disease in Malawi
T2  - Structural and Congenital Heart Disease

PY  - 2019
VL  - 14
IS  - 4
SN  - 3071-1738

AB  - <b>Background:</b> In asymptomatic children, screening echocardiography has been used to 
attempt to diagnose rheumatic heart disease (RHD) at an early stage (latent RHD). 
World Heart Federation guidelines have standardized categorization of “definite,” 
“borderline,” or no RHD by echo findings. The progression of RHD diagnosed through 
echo screening is not known. In 2014, we screened 1450 schoolchildren in Malawi.<br/>
<b>Objective:</b> Our objective was to evaluate 2‐year RHD evolution among those diag‐
nosed through screening.<br/>
<b>Methods:</b> Two‐year follow‐up echocardiograms of those diagnosed with latent RHD 
were read by a primary, secondary, then third reader if there was disagreement. 
Progression or regression of both definite and borderline groups were tabulated. 
Penicillin adherence, age, gender, number in home, and household income were com‐
pared between those with definite RHD who regressed to borderline and those that 
stayed definite. We utilized the local system used to track HIV defaulters in order to 
bring participants back into care. Comparisons were made using Fisher’s exact and 
Wilcoxon rank‐sum tests.<br/>
<b>Results:</b> Of the 39 with borderline RHD, 1 was lost to follow‐up (2.6%), 1 progressed 
to definite (2.6%), 19 remained borderline (48.7%), 17 (43.6%) regressed to normal, 
and 1 was reclassified as mitral valve prolapse (2.6%). Of the 11 with definite RHD, 6 
(54.5%) remained definite, 4 regressed to borderline (36.4%), and 1 regressed to nor‐
mal (9.1%). Two of 11 with definite RHD had penicillin adherence above 80% for the 
2‐year follow‐up period. There were no differences in adherence, gender, age, house‐
hold income, or number in household between those with definite RHD that re‐
gressed to borderline and those who did not (P > .19).<br/>
<b>Conclusions:</b> Borderlines had a very low progression rate to definite RHD. A strength 
of our study was a high retention rate (98%). Longer follow‐up is needed to determine 
expected disease evolution.
KW  - echocardiography
KW  -  global health
KW  -  pediatric cardiology
KW  -  rheumatic heart disease
KW  -  screening

DO  - 10.1111/chd.12756