March 16, 2026International Journal of Cardiology1 citationsOpen Access
Early rheumatic heart disease is a recognized intermediate on the pathway to advanced rheumatic heart disease
Key Points
- The aim is to highlight early rheumatic heart disease as a critical intermediate stage toward advanced disease.
- Discussed the role of echocardiographic screening in detecting early RHD.
- Reviewed evidence on the natural history of rheumatic heart disease.
- Analyzed clinical implications for prevention strategies.
- Identified a significant presence of mild, clinically silent RHD not linked to prior acute rheumatic fever.
- Demonstrated that early RHD may affect many individuals on the way to advanced RHD.
- Highlighted new targets for vaccine trials against Streptococcus pyogenes.
Abstract
Rheumatic heart disease is a major cause of premature cardiovascular morbidity and mortality globally.Over the past decade, echocardiographic screening has changed our understanding of the natural history of RHD, revealing a high burden of clinically silent, mild RHD among people who cannot recall a history of preceding acute rheumatic fever.This viewpoint outlines the evidence that this earliest form of rheumatic heart disease, only detectable through echocardiographic screening, is an intermediate stage that many, but not all, individuals may pass through on the pathway to advanced rheumatic heart disease.This shift in understanding has important clinical and research implications, including introducing a new and more pragmatic target for Streptococcus pyogenes vaccine trials for the indication of rheumatic heart disease prevention.
Cite This Study
Marangou et al. (2026) studied this question. Echocardiographic screening identifies a significant burden of clinically silent, mild rheumatic heart disease as an intermediate stage before advanced disease.