Figure 1
Study flow chart.
Table 1
Baseline characteristics of population.
| VALUES | 95% CONFIDENCE INTERVAL | |
|---|---|---|
| Total population | 15130 | … |
| Age, years | 12.2 ± 3.1 | 12.1 – 12.3 |
| Gender | ||
| Boys | 7894 (52.2%) | 51.4 – 53.0 |
| Girls | 7236 (47.8%) | 47.0 – 48.6 |
| School type | ||
| State-run | 13167 (87%) | 86.5 – 87.5 |
| Private | 1963 (13%) | 12.5 – 13.5 |
| Parental consanguinity | 3954 (26.1%) | 25.4 – 26.8 |
| Father literacy* | ||
| High school diploma or less | 10362 (73.6%) | 72.9 – 74.3 |
| University degrees | 3719 (26.4%) | 25.7 – 27.1 |
| Mother literacy* | ||
| High school diploma or less | 10867 (76.7%) | 76.0 – 77.4 |
| University degrees | 3297 (23.3%) | 22.6 – 24.0 |
| Number of children in family | ||
| 1 child | 3397 (22.5%) | 21.8 – 23.2 |
| 2 children | 7629 (50.4%) | 49.6 – 51.2 |
| 3 children | 2941 (19.4%) | 18.8 – 20.0 |
| ≥4 children | 1163 (7.7%) | 7.3 – 8.1 |
| Height,† cm | 151.4 ± 17.2 | 151.1 – 151.6 |
| Weight,† kg | 48.4 ± 18.8 | 48.1 – 48.7 |
| Waist circumference,† cm | 70.2 ± 11.4 | 70.1 – 70.4 |
| Systolic blood pressure,† mm Hg | 113.9 ± 12.2 | 113.7 – 114.1 |
| Diastolic blood pressure,† mm Hg | 72.3 ± 7.6 | 72.2 – 72.4 |
| Arterial oxygen saturation, % | 97.3 ± 1.6 | 97.2 – 97.4 |
[i] * These data were not available in about 7% of individuals.
† These data are not available in about 3% of participants.
Data are presented as number (%) or mean ± SD.
Table 2
The frequency of CHDs and cardiomyopathies among students.
| NUMBERS DETECTED BY VSCAN (%) | NUMBERS DETECTED BY STE, % (95% CONFIDENCE INTERVAL) | CRUDE RATE, PER 1000 PERSONS (95% CONFIDENCE INTERVAL) | |
|---|---|---|---|
| Total CHD* | 172 (1.137%) | 152, 1.005% (0.852 - 1.180) | 10.046 (8.519 – 11.766) |
| Atrial septal defect | 54 (0.357%) | 50, 0.330% (0.245 – 0.435) | 3.305 (2.454 – 4.355) |
| Patent foramen ovale | 37 (0.245%) | 33, 0.220% (0.150 – 0.306) | 2.181 (1.502 – 3.062) |
| Bicuspid aortic valve | 24 (0.159%) | 20, 0.132% (0.080 – 0.204) | 1.322 (0.808 – 2.041) |
| Patent ductus arteriosus | 18 (0.119%) | 16, 0.106% (0.060 – 0.172) | 1.058 (0.605 – 1.717) |
| Ventricular septal defect | 17 (0.112%) | 16, 0.106% (0.060 – 0.172) | 1.058 (0.605 – 1.717) |
| Coarctation of aorta | 6 (0.040%) | 6, 0.040% (0.015 – 0.090) | 0.397 (0.145 – 0.863) |
| Isolated PA dilatation | 5 (0.033%) | 2, 0.013% (0.001 – 0.048) | 0.132 (0.016 – 0.478) |
| Sub-aortic web | 4 (0.026%) | 4, 0.026% (0.007 – 0.068) | 0.264 (0.072 – 0.677) |
| Isolated sinus valsalva dilatation | 4 (0.026%) | 2, 0.013% (0.001 – 0.048) | 0.132 (0.016 – 0.478) |
| Persistent LSVC | 3 (0.019%) | 3, 0.020% (0.004 – 0.058) | 0.198 (0.040 – 0.580) |
| Pulmonary valve stenosis | 2 (0.013%) | 2, 0.013% (0.001 – 0.048) | 0.132 (0.016 – 0.478) |
| Isolated right aortic arch | 1 (0.007%) | 1, 0.007% (0.001 – 0.037) | 0.070 (0.001 – 0.370) |
| Supravalvular mitral mass | 1 (0.007%) | 1, 0.007% (0.001 – 0.037) | 0.070 (0.001 – 0.370) |
| Quadricuspid aortic valve | 1 (0.007%) | 1, 0.007% (0.001 – 0.037) | 0.070 (0.001 – 0.370) |
| Aortic valve stenosis | 1 (0.007%) | 1, 0.007% (0.001 – 0.037) | 0.070 (0.001 – 0.370) |
| Isolated aorta dilatation | 1 (0.007%) | 1, 0.007% (0.001 – 0.037) | 0.070 (0.001 – 0.370) |
| Situs inversus | 1 (0.007%) | 1, 0.007% (0.001 – 0.037) | 0.070 (0.001 – 0.370) |
| Tetralogy of Fallot | 1 (0.007%) | 1, 0.007% (0.001 – 0.037) | 0.070 (0.001 – 0.370) |
| Transposition of great arteries | 1 (0.007%) | 1, 0.007% (0.001 – 0.037) | 0.070 (0.001 – 0.370) |
| Other abnormalities* | |||
| Redundant interatrial septum | 862 (5.700%) | NA | NA |
| Aneurysmal interatrial septum | 47 (0.310%) | NA | NA |
| Cardiomyopathies | 32 (0.212%)† | 9, 0.065% (0.023 – 0.113) | 0.595 (0.272 – 1.129) |
| Idiopathic PAH‡ | 1 (0.007%) | 1, 0.007% (0.001 – 0.037) | 0.070 (0.001 – 0.370) |
[i] CHD denotes congenital heart disease, LSVC left superior vena cava, NA not applicable, PA pulmonary artery, PAH pulmonary arterial hypertension, and STE standard transthoracic echocardiography.
* All pathologies included those of known/repaired cases and newly diagnosed cases.
† These cases identified by Vscan included isolated reduced left ventricular ejection fraction (ie, less than 55% by the eyeball assessment), isolated ventricular hypertrophy and/or isolated cardiac chamber dilatation with or without reduced ventricular function suggestive for cardiomyopathies, myocarditis, or other organ damages requiring further evaluations.
‡ Patient had finger clubbing and decreased levels of arterial oxygen saturation.
Table 3
The frequency of valvular involvements among students.
| NUMBERS DETECTED BY VSCAN (%) | NUMBERS DETECTED BY STE, % (95% CONFIDENCE INTERVAL) | CRUDE RATE, PER 1000 PERSONS (95% CONFIDENCE INTERVAL) | |
|---|---|---|---|
| AV pathologies | |||
| AV regurgitation ≤mild severity | 164 (1.084%) | 25, 0.165% (0.107 – 0.243) | 1.652 (1.070 – 2.438) |
| AV regurgitation >mild severity | 14 (0.092%) | 14, 0.092% (0.050 – 0.155) | 0.925 (0.506 – 1.552) |
| AV billowing | 10 (0.06%) | NC | … |
| AV prolapse of any grade | 2 (0.013%) | 2, 0.013% (0.001 – 0.047) | 0.132 (0.016 – 0.477) |
| MV pathologies | |||
| MV regurgitation ≤mild severity | 863 (5.703%) | NC | … |
| MV regurgitation >mild severity | 384 (2.538%) | 90, 0.595% (0.478 – 0.730) | 5.950 (4.786 – 7.307) |
| MV billowing | 530 (3.502%) | NC | … |
| MV prolapse ≥mild severity | 302 (1.996%) | NC | … |
| TV pathologies | |||
| TV regurgitation ≤mild severity | 1624 (10.733%) | NC | … |
| TV regurgitation ≥moderate severity | 55 (0.363%) | 55, 0.363% (0.274 – 0.473) | 3.635 (2.740 – 4.730) |
| TV prolapse any grade | 2 (0.013%) | 2, 0.013% (0.001 – 0.047) | 0.132 (0.016 – 0.477) |
| PV pathologies | |||
| PV regurgitation ≤mild severity | 1014 (6.701%) | NC | … |
| PV regurgitation ≥moderate severity | 44 (0.290%) | 44, 0.290% (0.211- 0.390) | 2.908 (2.114 – 3.902) |
[i] AV denotes aortic valve, MV mitral valve, NC not checked, PV pulmonary valve, STE standard transthoracic echocardiography, TV tricuspid valve.
* Other valvular pathologies are categorized as congenital heart disease in prior table.
Table 4
The comparison of individuals with or without CHD.
| WITH CHD N = 152 | WITHOUT CHD N = 14978 | P VALUE | |
|---|---|---|---|
| Age, years | 11.7 ± 2.9 | 12.2 ± 3.1 | 0.026 |
| Gender | 0.353 | ||
| Boys | 85 (55.9%) | 7809 (52.1%) | |
| Girls | 67 (44.1%) | 7169 (47.9%) | |
| School type | 0.367 | ||
| Public | 136 (89.5%) | 13031 (87%) | |
| Private | 16 (10.5%) | 1947 (13%) | |
| Parental consanguinity | 63 (41.4%) | 3887 (26%) | <0.001 |
| Father literacy* | 0.061 | ||
| High school diploma or less | 122 (80.3%) | 10240 (73.5%) | |
| University degrees | 30 (19.7%) | 3689 (26.5%) | |
| Mother literacy* | 0.514 | ||
| High school diploma or less | 120 (78.9%) | 10747 (76.7%) | |
| University degrees | 32 (21.1%) | 3265 (23.3%) | |
| Number of children in family | 0.718 | ||
| 1 child | 31 (20.4%) | 3366 (22.5%) | |
| 2 children | 75 (49.3%) | 7554 (50.4%) | |
| 3 children | 31 (20.4%) | 2910 (19.4%) | |
| ≥4 children | 15 (9.9%) | 1148 (7.7%) | |
| Height, cm | 149.5 ± 16.2 | 151.3 ± 17.2 | 0.200 |
| Weight, kg | 45.3 ± 16.6 | 48.4 ± 18.8 | 0.049 |
| Waist circumference, cm | 68.8 ± 10.5 | 70.2 ± 11.4 | 0.130 |
| Systolic blood pressure, mm Hg | 113 ± 12.1 | 113.9 ± 12.2 | 0.351 |
| Diastolic blood pressure, mm Hg | 71.8 ± 7.8 | 72.3 ± 7.6 | 0.468 |
| Arterial oxygen saturation, % | 97 ± 2.6 | 97.2 ± 1.6 | 0.089 |
[i] CHD denotes congenital heart disease.
* These data were not available in 6–7% of individuals.
Data are presented as number (%) or mean ± SD.
Figure 2
Multivariable analyses showing predictors of echocardiographic findings among individuals with (A) SHD, (B) CHD, (C) non-rheumatic VHD, and (D) RHD. The horizontal lines indicate the 95% confidence intervals (CIs) for the odds ratios (ORs), and the diamonds in the middle of the horizontal lines indicate the OR of the predictor entered in the multivariable model.