2025

JACC March 12, 2019

Volume 73, Issue 9

Valvular Heart Disease

HIGH PREVALENCE OF RHEUMATIC HEART DISEASE IN 2603 SCHOOL CHILDREN IN NORTH-WEST
INDIA WITH 6 MONTHS AND 2 YEARS FOLLOW-UP: AN ECHOCARDIOGRAPHIC SURVEY
Poster Contributions
Poster Hall, Hall F
Monday, March 18, 2019, 9:45 a.m.-10:30 a.m.

Session Title: Valvular Heart Disease: Clinical 5

Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1337-462

Authors: Raja Babu Panwar, Bal Kishan Gupta, Arvind Kumar Sharma, Dinesh Choudhary, Sadik Panwar, Nidhi Priya, Rajeev Gupta, S. P.
Medical College, Bikaner, India, RUHS, Jaipur, India
Background: Prevalence of rheumatic heart disease (RHD) appears to be declining in India and other developing countries.
Echocardiographic criteria have been defined by World Heart Federation (WHF) for its diagnosis but used only infrequently. To determine
prevalence of RHD using latest criteria we performed a study among school children at Bikaner, North-West India.
Methods: We performed a stratified random sampling technique and identified 30 co-educational government and non-government urban
and rural schools in Bikaner district. Successively enrolled school children were invited for echocardiography. The present study reports the
results of first 2603 children (age 10-15years) and follow-up at 6 months to 2 years. Cardiac auscultation and echocardiographic study was
performed in all. A blinded expert later confirmed the echocardiographic findings.
Results: Clinical or auscultatory diagnosis of RHD was not made in any child. We diagnosed 78cases of definite, 21 of borderline RHD
while 6 cases had definitive aortic & borderline mitral valve disease in same patients using WHF criteria with a prevalence rate of 40.33
per 1,000. Prevalence rate/1000 was greater in children 10-12y(50.2) vs13-15y (25.2) (p=0.043), in government (75.8) vs non-government
schools (31.7) (p=0.013), in children on less literate mothers (67.4) vs more literate (21.2) (p=0.0005),and similar in boys (38.0) and girls
(37.5) (p=0.96). No children with RHD had history of acute rheumatic fever. Over 6 to 24 months follow-up period, 36 RHD children were
reassessed. Out of 26 definitive cases, 20 remained same while 6 definitive cases were converted to normal (2 cases) and borderline (3
cases), 8 borderlines cases remained same so total borderlines were 11 during this period. The Echocardiography status had improved
(r=-2.43, p=<0.05) between 6 months to 2 years.
Conclusion: This study shows a high prevalence of RHD among school children in North-West India and reflects very high burden in
developing world. Perhaps globally echocardiography is recommended instead of exclusion by clinical examination alone.