Four year follow-up of Black schoolchildren with non-ejection systolic clicks and mitral systolic murmurs

doi:10.1016/0002-8703(78)90498-2

American Heart Journal

Volume 95, Issue 6, June 1978, Pages 697-701

https://doi.org/10.1016/0002-8703(78)90498-2 Get rights and content

Abstract

In 1972 we conducted a survey of 12,050 urban Black schoolchildren and detected 168 (prevalence rate of 14 per 1,000) with a non-ejection systolic click (NESC), a late systolic murmur, or both. The etiology of the mitral valve abnormality was unknown but we considered that a significant proportion might have early rheumatic heart disease.

The ausculatory features four years later of 139 of the original 168 subjects as well as those of 139 age- and sex-matched controls are presented in this study. No cardiac abnormality was detected in as many as 55 of the subjects. Five children now had pansystolic murmurs but the mitral regurgitation was assessed as mild in four. Twenty-five (17.9 per cent) of the controls, 23 of whom had NESCs, had auscultatory features compatible with mitral valve prolapse.

These findings do not support our earlier suggestion that a large number of the 1972 subjects have mild rheumatic heart disease. The results are in accord with other studies which have indicated that auscultatory features compatible with mitral valve prolapse are common in “normals” and also that the prognosis of the specific “billowing mitral leaflet syndrome” is generally benign.

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Citation Excerpt :
Supporting the echocardiographic follow-up studies, clinical studies prior to the echocardiographic era also showed similar results. In a 4- year follow-up study of patients with abnormalities detected on auscultation, patients with short systolic murmurs and nonejection clicks (most likely corresponding to borderline disease using today's definitions) were most likely to regress or persist with very few progressing to overt RHD [38]. In comparison, patients with bona fide murmurs were found to have persistent clinical findings with a small percentage requiring tertiary follow-up or intervention [39].
In this review, we make the case that currently available figures used to define the global burden of acute rheumatic fever and rheumatic heart disease, although crucial to control efforts, are imperfect. Data have been hindered by methodological differences between studies, by patchy coverage within countries and across regions, and by an incomplete understanding of the relationship between echocardiographic detection of asymptomatic mild disease and progression to symptomatic disease. We argue that in order to advocate effectively for patients with rheumatic heart disease now and into the future, true burden of disease estimates on local, national, and international levels are urgently required. We critically review previous burden of disease estimates and outline the issues in defining the “true” burden of rheumatic heart disease, and we propose a new model for rheumatic heart disease epidemiologic studies. This is of particular relevance in 2012 with an ever-increasing burden of cardiovascular disease globally.
Exercise-induced regurgitation in mitral valve prolapse: Is it a new disease?
1995, Journal of the American College of Cardiology
Implications of mitral valve prolapse in children with rheumatic mitral regurgitation
1994, Journal of the American College of Cardiology
Objectives. This study was conducted to determine the longterm prognosis of children with mitral valve prolapse associated with isolated rheumatic mitral regurgitation.
Background. Rheumatic fever may result in mitral valve prolapse, which sometimes leads to severe mitral regurgitation requiring surgical intervention during the active stage of rheumatic fever. However, the influence of mitral valve prolapse on the prognosis of patients with rheumatic mitral regurgitation remains largely unknown.
Methods. From 1971 to 1991, 181 children who fulfilled the revised Jones criteria of rheumatic fever were identified from a rheumatic fever prevention program. Of the 181 patients, isolated mitral regurgitation was diagnosed in 123 at age 4 to 12 years. The diagnosis of mitral valve prolapse was based on echocardiographic findings. Actuarial event-free curves for persistent murmur, cardiac improvement and surgical intervention were drawn according to the Kaplan-Meier nonparametric estimation.
Results. Evidence of mitral valve prolapse was shown to 37 (30%) of the 123 patients. Patients with mitral valve prolapse were more likely to have a larger cardiac size than those without mitral valve prolapse during the active stage of rheumatic fever. Although the cardiac status of patients with mitral valve prolapse may improve under adequate secondary prophylaxis, an actuarial analysis indicated that patients with mitral valve prolapse had a greater likelihood of murmur persistence and surgical intervention. This trend toward murmur persistence was observed even when patients with heart failure during the active stage of rheumatic fever were excluded from analysis.
Conclusions. The presence of mitral valve prolapse in children with isolated rheumatic mitral regurgitation may predict a less favorable outcome.
Mitral valve prolapse and the mitral valve prolapse syndrome
1991, Current Problems in Cardiology

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^☆: Supported by a grant from the Stella and Paul Loewenstein Trust Cardiac Fund of the University of the Witwatersrand.

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Clinical communicationFour year follow-up of Black schoolchildren with non-ejection systolic clicks and mitral systolic murmurs☆

Abstract

Progr. Cardiovasc. Dis.

Am. J. Cardiol.

Am. Heart J.

Am. Heart J.

Am. J. Cardiol.

Epidemiology of rheumatic heart disease in black schoolchildren of Soweto, Johannesburg

Br. Med. J.

Non-ejection systolic clicks and mitral systolic murmurs in black schoolchildren of Soweto, Johannesburg

Br. Heart J.

Mitral valve prolapse in one hundred presumably healthy young females

Circulation

Prevalence of clinical mitral valve prolapse in 1169 young women

N. Engl. J. Med.

Incidence of mitral valve prolapse in the asymptomatic normal

Circulation

Clinical communication
Four year follow-up of Black schoolchildren with non-ejection systolic clicks and mitral systolic murmurs☆