Quantifying cardiac inflammation in acute rheumatic fever and rheumatic heart disease

Dr Jessica O'Brien, Monash University

2020 Aboriginal and Torres Strait Islander Award

Years funded: 2021-2023

Rheumatic fever (RF) and rheumatic heart disease (RHD) remain an ongoing and preventable cause of heart disease affecting Aboriginal Australians and/or Torres Strait Islander people (hereafter referred to as Indigenous Australians). The diagnosis of RF is based on the presence of signs or symptoms (including fever, arthritis, central nervous system involvement, skin lesions and cardiac manifestations) rather than a definitive investigation. This can lead to instances where the diagnosis is uncertain and diagnostic categories of possible, probable, and definite have been proposed. Failure to diagnose RF accurately is of particular concern given secondary antibiotic prophylaxis is important in the prevention of further RF as well as progression to RHD-related valvular heart disease.

This multi-site research will use cardiac MRI in Alice Springs, Darwin, Cairns and Townsville to identify and quantify cardiac inflammation in patients with confirmed or suspected RF. A score of extent of inflammation will be developed to aid in the diagnosis of RF, such that more confidence can be placed in the accuracy of diagnosis and therefore the need for ongoing secondary antibiotic prophylaxis. Cardiac MRI will be repeated 2-3 years after the initial scan to repeat the inflammation score and monitor for progression to RHD.

This research has the capacity to change how we diagnose RF and also to identify those RF patients who are at higher risk for progression to RHD, and therefore most likely to obtain benefit from antibiotic prophylaxis and close clinical follow-up. We believe this will contribute to the improvement of health outcomes in Australia's First Nations people who have, or are at risk of, RF and RHD.