Prevalence of Structural Heart Diseases Detected by Handheld Echocardiographic Device in School-Age Children in Iran: The SHED LIGHT Study

Saeid Hosseini; Niloufar Samiei; Avisa Tabib; Hooman Bakhshandeh; Yousef Rezaei; Mozhgan Parsaee; Fariba Rashidi Ghader; Maryam Moradian; Maryam Shojaeifard; Zahra Khajali; Sepideh Taghavi; Nasim Naderi; Golnar Mortaz Hejri; Homa Ghaderian; Golnaz Houshmand; Raheleh Kaviani; Melody Farrashi; Marziyeh Pakbaz; Hoda Mombeini; Sedigheh Saedi; Alireza Alizadeh Ghavidel; Gholamreza Omrani; Ahmad Mohebbi; Mohammad Mehdi Peighambari; Mohammad Rafie Khorgami; Akbar Nikpajouh; Ahmad Amin; Majid Maleki; Carlos A. Mestres; Luigi Paolo Badano; Feridoun Noohi; On Behalf of the SHED LIGHT Investigators

doi:10.5334/gh.1121

Prevalence of Structural Heart Diseases Detected by Handheld Echocardiographic Device in School-Age Children in Iran: The SHED LIGHT Study

Volume 17 (2022): Issue 1

By: Saeid Hosseini , Niloufar Samiei , Avisa Tabib , Hooman Bakhshandeh , Yousef Rezaei , Mozhgan Parsaee , Fariba Rashidi Ghader , Maryam Moradian , Maryam Shojaeifard , Zahra Khajali , Sepideh Taghavi , Nasim Naderi , Golnar Mortaz Hejri , Homa Ghaderian , Golnaz Houshmand , Raheleh Kaviani , Melody Farrashi , Marziyeh Pakbaz , Hoda Mombeini , Sedigheh Saedi , Alireza Alizadeh Ghavidel , Gholamreza Omrani , Ahmad Mohebbi , Mohammad Mehdi Peighambari , Mohammad Rafie Khorgami , Akbar Nikpajouh , Ahmad Amin , Majid Maleki , Carlos A. Mestres , Luigi Paolo Badano , Feridoun Noohi and On Behalf of the SHED LIGHT Investigators

Open Access

|Jun 2022

Abstract

Background: Structural heart disease (SHD) has great impacts on healthcare systems, creating further public health concerns. Proper data are scant regarding the magnitude of the affected population by SHD.

Objectives: This study aimed to determine the prevalence of SHD among children and adolescents in an Iranian population.

Methods: In this population-based study, a multistage cluster-random sampling was used to choose schools from the Tehran urban area. All students were examined using a handheld Vscan device by echocardiographer, and the results were concurrently supervised and interpreted by cardiologists. All the major findings were reevaluated in hospital clinics.

Results: Of 15,130 students (6–18 years, 52.2% boys) who were examined, the prevalence of individuals with congenital heart disease (CHD) and cardiomyopathy was 152 (10.046 per 1,000 persons) and 9 (0.595 per 1,000 persons), respectively. The prevalence of definite and borderline rheumatic heart disease (RHD) was 30 (2 per 1,000 persons) and 113 (7.5 per 1,000 persons), correspondingly. Non-rheumatic valvular heart disease (VHD) was also detected in 465 (30.7 per 1,000 persons) students. Of all the pathologies, only 39 (25.6%) cases with CHD and 1 (0.007%) cases with RHD had already been diagnosed. Parental consanguinity was the strongest predictor of CHD and SHD (odds ratio [OR]: 1.907, 95% CI, 1.358 to 2.680; P < 0.001 and OR, 1.855, 95% CI, 1.334 to 2.579; P < 0.001, respectively). The female sex (OR, 1.262, 95% CI, 1.013 to 1.573; P = 0.038) and fathers’ low literacy (OR, 1.872, 95% CI, 1.068 to 3.281; P = 0.029) were the strongest predictors of non-rheumatic VHD and RHD, correspondingly.

Conclusions: The implementation of echocardiographic examinations for detecting SHD among young population is feasible which detected SHD prevalence in our population comparable to previous reports. Further studies are required to delineate its economic aspects for community-based screening.

References

Beaton A, Aliku T, Dewyer A, et al. Latent rheumatic heart disease: Identifying the children at highest risk of unfavorable outcome. Circulation. 2017; 136: 2233–44. DOI: 10.1161/CIRCULATIONAHA.117.029936
Open DOI Search in Google Scholar Back to article
Baumgartner H, Bonhoeffer P, De Groot NMS, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010): The Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC). Eur Heart J. 2010; 31: 2915–57. DOI: 10.1093/eurheartj/ehq249
Open DOI Search in Google Scholar Back to article
Hoffman JI, Kaplan S, Liberthson RR. Prevalence of congenital heart disease. American Heart Journal. 2004; 147: 425–39. DOI: 10.1016/j.ahj.2003.05.003
Open DOI Search in Google Scholar Back to article
van der Bom T, Zomer AC, Zwinderman AH, Meijboom FJ, Bouma BJ, Mulder BJ. The changing epidemiology of congenital heart disease. Nat Rev Cardiol. 2011; 8: 50–60. DOI: 10.1038/nrcardio.2010.166
Open DOI Search in Google Scholar Back to article
Nugent AW, Daubeney PE, Chondros P, et al. The epidemiology of childhood cardiomyopathy in Australia. The New England Journal of Medicine. 2003; 348: 1639–46. DOI: 10.1056/NEJMoa021737
Open DOI Search in Google Scholar Back to article
Sattur S, Bates S, Movahed MR. Prevalence of mitral valve prolapse and associated valvular regurgitations in healthy teenagers undergoing screening echocardiography. Exp Clin Cardiol. 2010; 15: e13–e15.
Search in Google Scholar Back to article
Lipshultz SE, Sleeper LA, Towbin JA, et al. The incidence of pediatric cardiomyopathy in two regions of the United States. The New England Journal of Medicine. 2003; 348: 1647–55. DOI: 10.1056/NEJMoa021715
Open DOI Search in Google Scholar Back to article
Roberts K, Maguire G, Brown A, et al. Echocardiographic screening for rheumatic heart disease in high and low risk Australian children. Circulation. 2014; 129: 1953–61. DOI: 10.1161/CIRCULATIONAHA.113.003495
Open DOI Search in Google Scholar Back to article
Marijon E, Ou P, Celermajer DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. The New England Journal of Medicine. 2007; 357: 470–6. DOI: 10.1056/NEJMoa065085
Open DOI Search in Google Scholar Back to article
Mirabel M, Badano LP. Leveraging Mobile Technology to Reduce Resource-Related Health Care Disparities: Challenges and Opportunities. JACC Cardiovascular Imaging. 2018; 11: 558–60. DOI: 10.1016/j.jcmg.2017.08.015
Open DOI Search in Google Scholar Back to article
Tabib A, Samiei N, Peighambari MM, et al. Pocket-sized echocardiography for screening structural heart disease: diagnostic accuracy and cost-effectiveness for population-based studies. Cardiology in the Young. 2020: 1–8. DOI: 10.1017/S1047951119003111
Open DOI Search in Google Scholar Back to article
Lai WW, Geva T, Shirali GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography. 2006; 19: 1413–30. DOI: 10.1016/j.echo.2006.09.001
Open DOI Search in Google Scholar Back to article
Williams K, Thomson D, Seto I, et al. Standard 6: age groups for pediatric trials. Pediatrics. 2012; 129(Suppl 3): S153–60. DOI: 10.1542/peds.2012-0055I
Open DOI Search in Google Scholar Back to article
GBD 2017 Congenital Heart Disease Collaborators. Global, regional, and national burden of congenital heart disease, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017. The Lancet Child & Adolescent Health. 2020; 4: 185–200. DOI: 10.1016/S2352-4642(19)30402-X
Open DOI Search in Google Scholar Back to article
Gilboa SM, Devine OJ, Kucik JE, et al. Congenital Heart Defects in the United States: Estimating the Magnitude of the Affected Population in 2010. Circulation. 2016; 134: 101–9. DOI: 10.1161/CIRCULATIONAHA.115.019307
Open DOI Search in Google Scholar Back to article
Marelli AJ, Ionescu-Ittu R, Mackie AS, Guo L, Dendukuri N, Kaouache M. Lifetime prevalence of congenital heart disease in the general population from 2000 to 2010. Circulation. 2014; 130: 749–56. DOI: 10.1161/CIRCULATIONAHA.113.008396
Open DOI Search in Google Scholar Back to article
Malhotra A, Dhutia H, Finocchiaro G, et al. Outcomes of Cardiac Screening in Adolescent Soccer Players. The New England Journal of Medicine. 2018; 379: 524–34. DOI: 10.1056/NEJMoa1714719
Open DOI Search in Google Scholar Back to article
Corrado D, Basso C, Schiavon M, Thiene G. Screening for Hypertrophic Cardiomyopathy in Young Athletes. The New England Journal of Medicine. 1998; 339: 364–69. DOI: 10.1056/NEJM199808063390602
Open DOI Search in Google Scholar Back to article
Marijon E, Celermajer DS, Tafflet M, et al. Rheumatic heart disease screening by echocardiography: the inadequacy of World Health Organization criteria for optimizing the diagnosis of subclinical disease. Circulation. 2009; 120: 663–8. DOI: 10.1161/CIRCULATIONAHA.109.849190
Open DOI Search in Google Scholar Back to article
Remond M, Atkinson D, White A, et al. Are minor echocardiographic changes associated with an increased risk of acute rheumatic fever or progression to rheumatic heart disease? Biometrics. 2015; 198: 117–22. DOI: 10.1016/j.ijcard.2015.07.005
Open DOI Search in Google Scholar Back to article
Shrestha NR, Karki P, Mahto R, et al. Prevalence of Subclinical Rheumatic Heart Disease in Eastern Nepal: A School-Based Cross-sectional Study. JAMA Cardiology. 2016; 1: 89–96. DOI: 10.1001/jamacardio.2015.0292
Open DOI Search in Google Scholar Back to article
Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet (London, England). 2006; 368: 1005–11. DOI: 10.1016/S0140-6736(06)69208-8
Open DOI Search in Google Scholar Back to article
GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2018; 392: 1789–858. DOI: 10.1016/S0140-6736(18)32279-7
Open DOI Search in Google Scholar Back to article
Engelman D, Wheaton GR, Mataika RL, et al. Screening-detected rheumatic heart disease can progress to severe disease. Heart Asia. 2016; 8: 67–73. DOI: 10.1136/heartasia-2016-010847
Open DOI Search in Google Scholar Back to article
Kalayinia S, Maleki M, Mahdavi M, Mahdieh N. A novel de novo dominant mutation of NOTCH1 gene in an Iranian family with non-syndromic congenital heart disease. J Clin Lab Anal. 2019: e23147. DOI: 10.1002/jcla.23147
Open DOI Search in Google Scholar Back to article
Nabulsi MM, Tamim H, Sabbagh M, Obeid MY, Yunis KA, Bitar FF. Parental consanguinity and congenital heart malformations in a developing country. Am J Med Genet A. 2003; 116A: 342–47. DOI: 10.1002/ajmg.a.10020
Open DOI Search in Google Scholar Back to article
Baggish AL, Hutter AM, Jr., Wang F, et al. Cardiovascular screening in college athletes with and without electrocardiography: A cross-sectional study. Annals of Internal Medicine. 2010; 152: 269–75. DOI: 10.7326/0003-4819-152-5-201003020-00004
Open DOI Search in Google Scholar Back to article
Berkompas DC, Sagar KB. Accuracy of color Doppler transesophageal echocardiography for diagnosis of patent foramen ovale. Journal of the American Society of Echocardiography: Official Publication of the American Society of Echocardiography. 1994; 7: 253–6. DOI: 10.1016/S0894-7317(14)80395-7
Open DOI Search in Google Scholar Back to article
Alpert BS, Cook DH, Varghese PJ, Rowe RD. Spontaneous closure of small ventricular septal defects: ten-year follow-up. Pediatrics. 1979; 63: 204–6. DOI: 10.1542/peds.63.2.204
Open DOI Search in Google Scholar Back to article
Basso C, Boschello M, Perrone C, et al. An echocardiographic survey of primary school children for bicuspid aortic valve. The American Journal of Cardiology. 2004; 93: 661–3. DOI: 10.1016/j.amjcard.2003.11.031
Open DOI Search in Google Scholar Back to article
Movahed M-R, Hepner AD, Ahmadi-Kashani M. Echocardiographic prevalence of bicuspid aortic valve in the population. Heart, Lung & Circulation. 2006; 15: 297–99. DOI: 10.1016/j.hlc.2006.06.001
Open DOI Search in Google Scholar Back to article
Hillebrand M, Koschyk D, Hark Pt, et al. Diagnostic accuracy study of routine echocardiography for bicuspid aortic valve: a retrospective study and meta-analysis. Cardiovasc Diagn Ther. 2017; 7: 367–79. DOI: 10.21037/cdt.2017.05.03
Open DOI Search in Google Scholar Back to article

Articles in this issue

DOI: https://doi.org/10.5334/gh.1121 | Journal eISSN: 2211-8179

Journal RSS Feed

Language: English

Submitted on: Sep 30, 2022

Accepted on: Apr 25, 2022

Published on: Jun 15, 2022

Published by: Ubiquity Press

In partnership with: Paradigm Publishing Services

Publication frequency: 1 issue per year

Keywords:

Echocardiography,

Screening,

Structural heart disease,

Prevalence

© 2022 Saeid Hosseini, Niloufar Samiei, Avisa Tabib, Hooman Bakhshandeh, Yousef Rezaei, Mozhgan Parsaee, Fariba Rashidi Ghader, Maryam Moradian, Maryam Shojaeifard, Zahra Khajali, Sepideh Taghavi, Nasim Naderi, Golnar Mortaz Hejri, Homa Ghaderian, Golnaz Houshmand, Raheleh Kaviani, Melody Farrashi, Marziyeh Pakbaz, Hoda Mombeini, Sedigheh Saedi, Alireza Alizadeh Ghavidel, Gholamreza Omrani, Ahmad Mohebbi, Mohammad Mehdi Peighambari, Mohammad Rafie Khorgami, Akbar Nikpajouh, Ahmad Amin, Majid Maleki, Carlos A. Mestres, Luigi Paolo Badano, Feridoun Noohi, On Behalf of the SHED LIGHT Investigators, published by Ubiquity Press
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 17 (2022): Issue 1