{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T05:37:48Z","timestamp":1792474668056,"version":"4.5.0"},"reference-count":20,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2020,5,10]],"date-time":"2020-05-10T00:00:00Z","timestamp":1589068800000},"content-version":"unspecified","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003593","name":"Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","doi-asserted-by":"publisher","award":["310679\/2016-8"],"award-info":[{"award-number":["310679\/2016-8"]}],"id":[{"id":"10.13039\/501100003593","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006520","name":"Edwards Lifesciences","doi-asserted-by":"publisher","award":["Every Heartbeat Matters"],"award-info":[{"award-number":["Every Heartbeat Matters"]}],"id":[{"id":"10.13039\/100006520","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004901","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado de Minas Gerais","doi-asserted-by":"publisher","award":["Programa Pesquisador Mineiro, PPM-00428-17"],"award-info":[{"award-number":["Programa Pesquisador Mineiro, PPM-00428-17"]}],"id":[{"id":"10.13039\/501100004901","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,4,7]]},"published-print":{"date-parts":[[2020,5]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>\n                      Echocardiographic (echo) screening is an important tool to estimate rheumatic heart disease (RHD) prevalence, but the natural history of screen-detected RHD remains unclear. The PROVAR+ (\n                      <jats:italic>Programa de RastreamentO da VAlvopatia Reum\u00e1tica<\/jats:italic>\n                      ) study, which uses non-experts, telemedicine and portable echo, pioneered RHD screening in Brazil. We aimed to assess the mid-term evolution of Brazilian schoolchildren (5\u201318 years) with echocardiography-detected subclinical RHD and to assess the performance of a simplified score consisting of five components of the World Heart Federation criteria, as a predictor of unfavourable echo outcomes.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Public schools of underserved areas and private schools in Minas Gerais, southeast Brazil.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A total of 197 patients (170 borderline and 27 definite RHD) with follow-up of 29\u00b19 months were included. Median age was 14 (12\u201316) years, and 130 (66%) were woman. Only four patients in the definite group were regularly receiving penicillin.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Unfavourable outcome was based on the 2-year follow-up echo, defined as worsening diagnostic category, remaining with mild definite RHD or development\/worsening of valve regurgitation\/stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among patients with borderline RHD, 29 (17.1%) progressed to definite, 49 (28.8%) remained stable, 86 (50.6%) regressed to normal and 6 (3.5%) were reclassified as other heart diseases. Among those with definite RHD, 13 (48.1%) remained in the category, while 5 (18.5%) regressed to borderline, 5 (18.5%) regressed to normal and 4 (14.8%) were reclassified as other heart diseases. The simplified echo score was a significant predictor of RHD unfavourable outcome (HR 1.197, 95% CI 1.098 to 1.305, p&lt;0.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The simple risk score provided an accurate prediction of RHD status at 2-year follow-up, showing a good performance in Brazilian schoolchildren, with a potential value for risk stratification and monitoring of echocardiography-detected RHD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-036827","type":"journal-article","created":{"date-parts":[[2020,5,11]],"date-time":"2020-05-11T06:19:35Z","timestamp":1589177975000},"page":"e036827","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Validation of a simplified score for predicting latent rheumatic heart disease progression using a prospective cohort of Brazilian schoolchildren"],"prefix":"10.1136","volume":"10","clinical-trial-number":[{"clinical-trial-number":"nct03346525","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct03346525","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"B\u00e1rbara Martins","family":"Bechtlufft","sequence":"first","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5586-774X","authenticated-orcid":false,"given":"Bruno Ramos","family":"Nascimento","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"},{"name":"Departamento de Cl\u00ednica M\u00e9dica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"Sable","sequence":"additional","affiliation":[{"name":"Cardiology, Children\u2019s National Health System, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara Leal","family":"Fraga","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rcia Melo","family":"Barbosa","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana Drumond","family":"Reis","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adriana Costa","family":"Diamantino","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"},{"name":"FIPMoc University Center, Montes Claros, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zilda Maria Alves","family":"Meira","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra Regina Tolentino","family":"Castilho","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nayana Flamini","family":"Arantes","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaciane Krauss","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Luiz Padilha","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Statistics, Universidade Federal do Paran\u00e1, Curitiba, PR, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Breno De Filippo","family":"Rezende","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Waydder Ant\u00f4nio Aur\u00e9lio","family":"Costa","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Duarte","family":"Mata","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augusto Ferreira","family":"Pereira","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Luiz Pinho","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"},{"name":"Departamento de Cl\u00ednica M\u00e9dica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea Zawacki","family":"Beaton","sequence":"additional","affiliation":[{"name":"The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA"},{"name":"University of Cincinnati School of Medicine, Cincinnati, OH, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Carmo","family":"Pereira Nunes","sequence":"additional","affiliation":[{"name":"Servi\u00e7o de Cardiologia e Cirurgia Cardiovascular e Centro de Telessa\u00fade, Hospital das Cl\u00ednicas da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"},{"name":"Departamento de Cl\u00ednica M\u00e9dica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,10]]},"reference":[{"key":"2025121509403276000_10.5.e036827.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1603693"},{"key":"2025121509403276000_10.5.e036827.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)32279-7"},{"key":"2025121509403276000_10.5.e036827.3","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1017\/S1047951117001676","article-title":"A focussed single-view hand-held echocardiography protocol for the detection of rheumatic heart disease","volume":"28","author":"Diamantino","year":"2018","journal-title":"Cardiol Young"},{"key":"2025121509403276000_10.5.e036827.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2016.06.088"},{"key":"2025121509403276000_10.5.e036827.5","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.117.008039","article-title":"Comparison between different strategies of rheumatic heart disease echocardiographic screening in Brazil: data from the PROVAR (rheumatic valve disease screening program) study","volume":"7","author":"Nascimento","year":"2018","journal-title":"J Am Heart Assoc"},{"key":"2025121509403276000_10.5.e036827.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2013.09.013"},{"key":"2025121509403276000_10.5.e036827.7","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2012.7"},{"key":"2025121509403276000_10.5.e036827.8","doi-asserted-by":"publisher","DOI":"10.1186\/s12872-016-0210-x"},{"key":"2025121509403276000_10.5.e036827.9","doi-asserted-by":"crossref","DOI":"10.1161\/CIRCIMAGING.118.007928","article-title":"Simplified echocardiography screening criteria for diagnosing and predicting progression of latent rheumatic heart disease","volume":"12","author":"Nunes","year":"2019","journal-title":"Circ Cardiovasc Imaging"},{"key":"2025121509403276000_10.5.e036827.10","first-page":"370","article-title":"Challenges for the implementation of the first large-scale rheumatic heart disease screening program in Brazil: the PROVAR study experience","volume":"108","author":"Santos","year":"2017","journal-title":"Arq Bras Cardiol"},{"key":"2025121509403276000_10.5.e036827.11","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.11.099408"},{"key":"2025121509403276000_10.5.e036827.12","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1177\/1357633X16677902","article-title":"Telehealth solutions to enable global collaboration in rheumatic heart disease screening","volume":"24","author":"Lopes","year":"2018","journal-title":"J Telemed Telecare"},{"key":"2025121509403276000_10.5.e036827.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"2025121509403276000_10.5.e036827.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2016.03.006"},{"key":"2025121509403276000_10.5.e036827.15","doi-asserted-by":"publisher","DOI":"10.1136\/openhrt-2017-000702"},{"key":"2025121509403276000_10.5.e036827.16","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.117.029936"},{"key":"2025121509403276000_10.5.e036827.17","doi-asserted-by":"publisher","DOI":"10.1136\/heartasia-2016-010847"},{"key":"2025121509403276000_10.5.e036827.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2015.07.005"},{"key":"2025121509403276000_10.5.e036827.19","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-014-0925-3"},{"key":"2025121509403276000_10.5.e036827.20","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1111\/chd.12756","article-title":"Two-Year evolution of latent rheumatic heart disease in Malawi","volume":"14","author":"Sanyahumbi","year":"2019","journal-title":"Congenit Heart Dis"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-036827","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:41:38Z","timestamp":1765820498000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-036827"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5]]},"references-count":20,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5,10]]},"published-print":{"date-parts":[[2020,5]]}},"alternative-id":["10.1136\/bmjopen-2020-036827"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-036827","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5]]}}}