Latent RHD in children: Moderate to severe disease linked to poor outcomes
Latent rheumatic heart disease (RHD) diagnosis appears to be heterogeneous with variable disease outcomes, as reported in a recent study. Specifically, children with moderate to severe latent RHD have poor outcomes, while those with both borderline and mild definite RHD are at substantial risk of progression.
Researchers conducted a prospective natural history study, drawing data from the Ugandan RHD registry. They identified 227 children with latent RHD (median age at diagnosis 12 years) and ≥1 year of follow-up (median, 2.3 years), among whom 164 were borderline and 63 were definite (mild, n=42; moderate/severe, n=21).
Bivariate and multivariable logistic regression, Kaplan-Meier analysis, and Cox proportional hazards models facilitated identification of risk factors for unfavourable outcome and comparison of progression-free survival (PFS) between those treated and not treated with penicillin. Propensity and other matching methods with sensitivity analysis were applied to evaluate the penicillin effect.
Half (49.3 percent) of the children were prescribed prophylactic penicillin with overall adherence of 84.7 percent. Echocardiographic progression and improvement were recorded, respectively, in 47.6 and 9.5 percent in the group of children with moderate-to-severe definite RHD, and in 26.0 and 45.2 percent of those with mild definite RHD, and in 9.8 and 46.3 percent of those with borderline RHD.
Risk factors for an unfavourable outcome in children with mild definite RHD or borderline RHD included more advanced disease category, younger age and morphological mitral valve features.
“Although long-term outcome remains unclear, the initial change in latent RHD may be evident during the first 1 to 2 years following diagnosis,” researchers noted. “Natural history data are inherently limited, and a randomized clinical trial is needed to definitively determine the impact of penicillin prophylaxis on the trajectory of latent RHD.”