• Heart · Dec 2015

    Newly diagnosed rheumatic heart disease among indigenous populations in the Pacific.

    • Mariana Mirabel, Muriel Tafflet, Baptiste Noël, Tom Parks, Olivier Axler, Jacques Robert, Marie Nadra, Gwendolyne Phelippeau, Elodie Descloux, Cécile Cazorla, Isabelle Missotte, Shirley Gervolino, Yann Barguil, Bernard Rouchon, Sylvie Laumond, Thierry Jubeau, Corinne Braunstein, Jean-Philippe Empana, Eloi Marijon, and Xavier Jouven.
    • Département de Cardiologie, Hôpital Européen Georges Pompidou, Paris, France INSERM U970, Paris Cardiovascular Research Centre - PARCC, Paris, France Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
    • Heart. 2015 Dec 1; 101 (23): 1901-6.

    ObjectivesRheumatic heart disease (RHD) remains the leading acquired heart disease in the young worldwide. We aimed at assessing outcomes and influencing factors in the contemporary era.MethodsHospital-based cohort in a high-income island nation where RHD remains endemic and the population is captive. All patients admitted with newly diagnosed RHD according to World Heart Federation echocardiographic criteria were enrolled (2005-2013). The incidence of major cardiovascular events (MACEs) including heart failure, peripheral embolism, stroke, heart valve intervention and cardiovascular death was calculated, and their determinants identified.ResultsOf the 396 patients, 43.9% were male with median age 18 years (IQR 10-40)). 127 (32.1%) patients presented with mild, 131 (33.1%) with moderate and 138 (34.8%) with severe heart valve disease. 205 (51.8%) had features of acute rheumatic fever. 106 (26.8%) presented with at least one MACE. Among the remaining 290 patients, after a median follow-up period of 4.08 (95% CI 1.84 to 6.84) years, 7 patients (2.4%) died and 62 (21.4%) had a first MACE. The annual incidence of first MACE and of heart failure were 59.05‰ (95% CI 44.35 to 73.75) and 29.06‰ (95% CI 19.29 to 38.82), respectively. The severity of RHD at diagnosis (moderate vs mild HR 3.39 (0.95 to 12.12); severe vs mild RHD HR 10.81 (3.11 to 37.62), p<0.001) and ongoing secondary prophylaxis at follow-up (HR 0.27 (0.12 to 0.63), p=0.01) were the two most influential factors associated with MACE.ConclusionsNewly diagnosed RHD is associated with poor outcomes, mainly in patients with moderate or severe valve disease and no secondary prophylaxis.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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