ABSTRACT
BACKGROUND In New Caledonia, a South Pacific archipelago whose inhabitants comprise Melanesians, Europeans/whites, Wallisians, Futunans, Polynesians, and Asians, the prevalence of rheumatic heart disease (RHD) is 0.9% to 1% at ages 9 and 10. It could be higher at the age of 16, but this remains to be verified. METHODS AND RESULTS A total of 1530 Melanesian, Métis, white, Wallisian, Futunan, Polynesian, and Asian adolescents benefited from a transthoracic echocardiogram. Definite or borderline RHD, nonrheumatic valve lesions, congenital heart defects, family and personal history of acute rheumatic fever, and socioeconomic factors were collected. The prevalence of cardiac abnormalities was 8.1%, made up of 4.1% RHD including 2.4% definite and 1.7% borderline RHD, 1.7% nonrheumatic valve lesions, and 2.3% congenital anomalies. In whites and Asians, there were no cases of RHD. RHD was higher in the Wallisian, Futunan, and Polynesian group (7.6%) when compared with Melanesians (5.3%) and Métis (2.9%). The number of nonrheumatic valve lesions was not statistically different in the different ethnicities. The prevalence of RHD was higher in adolescents with a personal history of acute rheumatic fever, in those living in overcrowded conditions, and in those whose parents were unemployed or had low-income occupations, such as the farmers or manual workers. CONCLUSIONS RHD was 4 times higher in adolescents at age 16 than at ages 9 and 10 (4.1% versus 0.9%-1%). No cases of RHD were observed in whites and Asians. The determining factors were history of acute rheumatic fever and socioeconomic factors.
Subject(s)
Native Hawaiian or Other Pacific Islander , Rheumatic Heart Disease/ethnology , Adolescent , Age Factors , Echocardiography, Doppler, Color , Female , Humans , Male , New Caledonia/epidemiology , Prevalence , Prospective Studies , Race Factors , Rheumatic Heart Disease/diagnostic imaging , Risk Assessment , Risk Factors , Social Determinants of Health , Socioeconomic FactorsABSTRACT
BACKGROUND: Rheumatic heart disease (RHD) is an important public health issue, particularly in the Pacific region, but its true burden is unknown. OBJECTIVES: To evaluate the prevalence of rheumatic heart disease (RHD) in young adults from New Caledonia, based on echocardiography, and to evaluate the accuracy of dynamic criteria, focusing on mitral valve (MV) leaflet motion. METHODS: Blind analysis of echocardiography by three cardiologists; diagnosis of RHD required at least one dynamic criterion (exaggerated or restricted MV leaflet motion); subjects with morphological criteria (MV leaflet thickening), but without dynamic criteria, were considered as borderline. RESULTS: There were 834 subjects from three socioeconomic groups, aged 18-22 years: 699 had normal echocardiography; 93 (11.5%) had physiological regurgitation; nine (0.9%) had borderline RHD; and five (0.59%) had RHD. The prevalence of RHD in New Caledonia was thus estimated at 5.9 per 1000 (95% confidence interval 2.6-12.2). The RHD cases were of Pacific ethnicity. Physiological regurgitation was more frequent in Pacific subjects (13.7%) than in non-Pacific subjects (6.9%; P<0.0001). RHD was more prevalent in the lowest socioeconomic group. No disagreement occurred between the three reviewers concerning analysis of dynamic criteria; all disagreements were related to morphological criteria. CONCLUSIONS: The prevalence of echocardiographically diagnosed RHD in adults in New Caledonia is estimated at 5.9 per 1000; it occurs most frequently in Pacific subjects and those with low incomes. Dynamic criteria were more accurate and reproducible than standard morphological criteria.
