Subclinical rheumatic heart disease in an Eritrean high-school population, detected by echocardiography.

BACKGROUND AND AIM OF THE STUDY: In developing countries rheumatic heart disease (RHD) is still the most common acquired cardiovascular disease affecting children and young adults. The study aim was to investigate, via an echocardiographic screening, the prevalence of subclinical RHD in high-school students in Eritrea. METHODS: A total of 684 students (314 females, 370 males; mean age 16.7 years) was randomly selected from nine secondary high schools in different regions of Eritrea to assess, via clinical and echocardiographic examinations, the presence of subclinical RHD. The term 'subclinical' was used to define the disease at its early stage, when it could not be detected by clinical examination only. RESULTS: Evidence of RHD was found in 28 students (4%), and of suspected RHD in 23 students (3.3%). Only 26 students (51%) with RHD (both evident or suspected) had a murmur at cardiac auscultation, and only 25 (49%) had a history of previous sore throat and tonsillitis. No student had clinical symptoms. All students with evident or suspected RHD were sent to secondary prophylaxis. CONCLUSION: Despite involving only a limited population sample, the present study confirmed that, in Eritrea, there is a high prevalence (4%) of RHD among high-school-aged students. The data acquired demonstrated the importance of a clinical and echocardiographic surveillance, and the need to start a preventive campaign for rheumatic fever and RHD in this country. This has now been commenced in Eritrean primary schools, with the collaboration of local teachers.

Clinical characteristics, treatment, trajectories and outcome of patients with dilated cardiomyopathy in a national heart failure registry.

BACKGROUND: Available data on the clinical characteristics and prognosis of patients with heart failure (HF) due to dilated cardiomyopathy (DCM) derive mainly from tertiary care centres for cardiomyopathies or from drug trial sub-studies, which may entail a referral bias. METHODS: From 2008 to 2021, we enrolled in a nationwide HF Registry 1886 DCM patients and 3899 with ischemic heart disease (IHD). RESULTS: Patients with DCM were younger, more often female, had more commonly recent onset HF, left bundle branch block, and showed higher LV end-diastolic volume and lower LVEF than IHD. With respect to IHD, DCM patients received more often mineralocorticoid receptor antagonists, renin angiotensin system inhibitors and betablockers, the latter more commonly at doses ≥50% of target, and triple guideline-directed medical therapy (GDMT) (adjusted OR 1.411, 95% CI 1.247-1.595, p < .0001). During one-year follow-up, 819 patients (14.2%) died or were hospitalized for HF [187 (9.9%) DCM, 632 (16.2%) IHD]; DCM was associated with lower risk of the combined end-point (adjusted HR 0.745, 95% CI 0.625- 0.888, p = .0011). Among the 1954 patients with 1-year echocardiograms available, 1483 had LVEF≤40% at baseline; of these,166 (30.6%) DCM and 165 (17.5%) IHD improved their LVEF to >40% (p < .0001). DCM aetiology was associated with higher likelihood of LVEF improvement (adjusted OR 1.722, 95% CI 1.328 -2.233, p < .0001). CONCLUSIONS: DCM patients have a different clinical profile, greater uptake of GDMT and better outcomes than IHD subjects. A comprehensive management approach is needed to further address the risk of unfavorable outcomes in DCM.