Echocardiographic screening to determine progression of latent rheumatic heart disease in endemic areas: A systematic review and meta-analysis.
- 作者列表："Gutman SJ","Shemesh E","Marwick TH","Taylor AJ
BACKGROUND:The World Health Organisation previously recommended routine screening in school-aged children in countries with a high prevalence of rheumatic heart disease (RHD); however, it is unclear if screening-detected (latent) valve disease will inevitably evolve to a pathological lesion. Understanding the natural history of latent RHD is essential prior to recommendation of screening in endemic areas. Studies documenting the progression of latent RHD have had contrasting conclusions about the pathogenicity of latent valvular lesions. This review provides estimates of rates of progression of latent RHD. METHODS AND FINDINGS:In this systematic review and meta-analysis, we searched EMBASE, MEDLINE, Global Index Medicus, Africa Wide, Cochrane Database of Systematic Reviews and Global Health Database for studies published before April 30, 2019. Study data were extracted from all studies which reported follow-up data on progression of latent valve lesions. Studies with control cohorts were used to calculate comparative prevalence ratios. This study is registered with PROSPERO, number CRD42019119427. We identified 12 studies reporting follow-up data on latent RHD for 950 people in 9 countries. The estimated pooled prevalence rate for progression per year of latent RHD was 5%/year (95% CI 2-8). Eight studies reported on the progression of borderline latent RHD with an estimated pooled prevalence of 2%/year (95% CI 0-4). Three studies included control groups. There was a significant increase in the risk of progression of valvular disease in the latent group compared with controls (RR = 3.57 (95%CI = 1.65-7.70, P = 0.001). The overall risk of bias was low. Given most studies included penicillin administration we were unable to document the natural history of latent RHD. Furthermore, we were unable to perform a sensitivity analysis to determine the effect of administering penicillin prophylaxis on progression of valve disease given prescription of penicillin was not standardised. CONCLUSION:Latent RHD has a slow rate of progression but it is significantly higher compared to controls, with definite latent RHD having a higher rate of progression compared with borderline latent disease. There are a massive number of individuals at risk for RHD in the developing world as well as logistical challenges of screening and delivering penicillin prophylaxis. The low rate of progression from untargeted screening may be an important consideration in resource-constrained environments.
背景: 世界卫生组织先前建议在风湿性心脏病 (RHD) 高发国家的学龄儿童中进行常规筛查; 然而，筛查发现的 (潜伏的) 瓣膜疾病是否会不可避免地演变为病理病变尚不清楚。在建议在流行地区进行筛查之前，了解潜伏RHD的自然史是至关重要的。记录潜在RHD进展的研究对潜在瓣膜病变的致病性有对比的结论。本综述提供了潜在RHD进展率的估计。 方法和结果: 在本系统综述和荟萃分析中，我们检索了EMBASE，MEDLINE，Global Index Medicus，Africa Wide，Cochrane系统综述数据库和全球健康数据库中2019年4月30日之前发表的研究。研究数据从所有报告潜在瓣膜病变进展的随访数据的研究中提取。使用对照队列的研究来计算比较患病率比。本研究注册于PROSPERO，编号crd42019119427。我们确定了12项研究，报告了9个国家950人潜在RHD的随访数据。潜在RHD每年进展的估计汇总患病率为5%/年 (95% CI 2-8)。8项研究报告了临界潜伏RHD的进展，估计合并患病率为2%/年 (95% CI 0-4)。三项研究包括对照组。与对照组相比，潜伏组中瓣膜病进展的风险显著增加 (RR = 3.57 (1.65 CI = 7.70-0.001，P =)。偏倚的总体风险较低。鉴于大多数研究包括青霉素给药，我们无法记录潜在RHD的自然史。此外，我们无法进行敏感性分析以确定给予青霉素处方的青霉素预防对瓣膜疾病进展的影响不标准化。 结论: 潜伏RHD具有缓慢的进展速率，但与对照相比显著较高，与边缘潜伏疾病相比，确切的潜伏RHD具有较高的进展速率。在发展中国家，有大量个体面临RHD风险，以及筛选和提供青霉素预防的后勤挑战。在资源受限的环境中，非靶向筛选的低进展率可能是一个重要的考虑因素。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.