CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Albertino Damasceno, MD, PhD*,
Gad Cotter, MD,
Anastase Dzudie, MD,
Karen Sliwa, MD, PhD and
Bongani M. Mayosi, MBChB, DPhil
* Departamento de Medicina, Faculdade de Medicina, Universidade Eduardo Mondlane, Ave. Mao Tse Tung 836, Maputo, Moçambique (Email: tino_7117{at}yahoo.com.br).
We agree with Drs. Marijon and Jouven that the time has come for the adoption of echocardiographic screening as part of a strategy for the early detection of rheumatic heart disease in endemic regions of the world such as Africa, Southeast Asia, and the Asia-Pacific region. The Pan African Society of Cardiology (PASCAR) has called for the implementation of the Awareness-Surveillance-Advocacy-Prevention (A.S.A.P.) Programme for the prevention of rheumatic fever and rheumatic heart disease in Africa, which embraces echocardiographic screening as part of an effort to rid the continent of the scourge of rheumatic heart disease "in our own lifetime" (1,2).
Although we agree with the overall thrust of the comment by Drs. Marijon and Jouven, the statement that "rheumatic heart disease is the most frequent cause of heart failure in this region of the world" may only apply to children and young adults. A pooling study of 12 hospital-based case series involving 4,548 patients from 8 countries (Cameroon, Ghana, Kenya, Nigeria, Senegal, South Africa, Uganda, and Zimbabwe) has shown that hypertension (23%) is the leading cause of heart failure in sub-Saharan Africa, followed closely by rheumatic heart disease (22%), and cardiomyopathy (20%) (3).
Finally, the natural history of patients with "subclinical" (i.e., no history of rheumatic fever, no symptoms, no signs, no mitral stenosis) echocardiographic features suggestive of rheumatic heart disease that were detected in the study by Marijon et al. (4) is unknown. Studies are needed to examine the appropriate management of these cases with borderline abnormalities that are likely to be found in large numbers in through echocardiographic screening for rheumatic heart disease.
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References
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- Mayosi B, Robertson K, Volmink J, et al. The Drakensberg declaration on the control of rheumatic fever and rheumatic heart disease in Africa S Afr Med J 2006;96:229-230.
- Robertson KA, Volmink JA, Mayosi BM. Towards a uniform plan for the control of rheumatic fever and rheumatic heart disease in Africa—the Awareness Surveillance Advocacy Prevention (A.S.A.P.) Programme S Afr Med J 2006;96:241-245.[Medline]
- Mayosi BM. Contemporary trends in the epidemiology and management of cardiomyopathy and pericarditis in sub-Saharan Africa Heart 2007;93:1176-1183.[Abstract/Free Full Text]
- Marijon E, Ou P, Celermajer DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening N Engl J Med 2007;357:470-476.[Abstract/Free Full Text]
Related Article
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Early Detection of Rheumatic Heart Disease and Prevention of Heart Failure in Sub-Saharan Africa
- Eloi Marijon and Xavier Jouven
J. Am. Coll. Cardiol. 2008 51: 1125-1126.
[Full Text]
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