Evaluation of a focussed protocol for hand-held echocardiography and computer-assisted auscultation in detecting latent rheumatic heart disease in scholars

2015 ◽  
Vol 26 (6) ◽  
pp. 1097-1106 ◽  
Author(s):  
Liesl J. Zühlke ◽  
Mark E. Engel ◽  
Simpiwe Nkepu ◽  
Bongani M. Mayosi
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Sensitivity And Specificity ◽  
Large Scale ◽  
High Specificity ◽  
Test Reliability ◽  
Computer Assisted ◽  
Asymptomatic Patients ◽  
Hand Held Echocardiography ◽  
Rheumatic Heart

AbstractIntroductionEchocardiography is the diagnostic test of choice for latent rheumatic heart disease. The utility of echocardiography for large-scale screening is limited by high cost, complex diagnostic protocols, and time to acquire multiple images. We evaluated the performance of a brief hand-held echocardiography protocol and computer-assisted auscultation in detecting latent rheumatic heart disease with or without pathological murmur.MethodsA total of 27 asymptomatic patients with latent rheumatic heart disease based on the World Heart Federation criteria and 66 healthy controls were examined by standard cardiac auscultation to detect pathological murmur. Hand-held echocardiography using a focussed protocol that utilises one view – that is, the parasternal long-axis view – and one measurement – that is, mitral regurgitant jet – and a computer-assisted auscultation utilising an automated decision tool were performed on all patients.ResultsThe sensitivity and specificity of computer-assisted auscultation in latent rheumatic heart disease were 4% (95% CI 1.0–20.4%) and 93.7% (95% CI 84.5–98.3%), respectively. The sensitivity and specificity of the focussed hand-held echocardiography protocol for definite rheumatic heart disease were 92.3% (95% CI 63.9–99.8%) and 100%, respectively. The test reliability of hand-held echocardiography was 98.7% for definite and 94.7% for borderline disease, and the adjusted diagnostic odds ratios were 1041 and 263.9 for definite and borderline disease, respectively.ConclusionComputer-assisted auscultation has extremely low sensitivity but high specificity for pathological murmur in latent rheumatic heart disease. Focussed hand-held echocardiography has fair sensitivity but high specificity and diagnostic utility for definite or borderline rheumatic heart disease in asymptomatic patients.

scholarly journals Standard echocardiography versus handheld echocardiography for the detection of subclinical rheumatic heart disease: protocol for a systematic review

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e020140 ◽  
Author(s):  
Lisa H Telford ◽  
Leila H Abdullahi ◽  
Eleanor A Ochodo ◽  
Liesl J Zühlke ◽  
Mark E Engel
Keyword(s):  
Systematic Review ◽  
Developing Countries ◽  
Heart Disease ◽  
Diagnostic Accuracy ◽  
Rheumatic Heart Disease ◽  
Sensitivity And Specificity ◽  
Meta Analysis ◽  
High Specificity ◽  
Asymptomatic Patients ◽  
Rheumatic Heart

IntroductionRheumatic heart disease (RHD) is a preventable and treatable chronic condition which persists in many developing countries largely affecting impoverished populations. Handheld echocardiography presents an opportunity to address the need for more cost-effective methods of diagnosing RHD in developing countries, where the disease continues to carry high rates of morbidity and mortality. Preliminary studies have demonstrated moderate sensitivity as well as high specificity and diagnostic odds for detecting RHD in asymptomatic patients. We describe a protocol for a systematic review on the diagnostic performance of handheld echocardiography compared to standard echocardiography using the 2012 World Heart Federation criteria for diagnosing subclinical RHD.Methods and analysisElectronic databases including PubMed, Scopus, Web of Science and EBSCOhost as well as reference lists and citations of relevant articles will be searched from 2012 to date using a predefined strategy incorporating a combination of Medical Subject Heading terms and keywords. The methodological validity and quality of studies deemed eligible for inclusion will be assessed against review specific Quality Assessment of Diagnostic Accuracy Studies 2 criteria and information on metrics of diagnostic accuracy and demographics extracted. Forest plots of sensitivity and specificity as well as scatter plots in receiver operating characteristic (ROC) space will be used to investigate heterogeneity. If possible, a meta-analysis will be conducted to produce summary results of sensitivity and specificity using the Hierarchical Summary ROC method. In addition, a sensitivity analysis will be conducted to investigate the effect of studies with a high risk of bias.Ethics and disseminationEthics approval is not required for this systematic review of previously published literature. The planned review will provide a summary of the diagnostic accuracy of handheld echocardiography. Results may feed into evidence-based guidelines and should the findings of this review warrant a change in clinical practice, a summary report will be disseminated among leading clinicians and healthcare professionals in the field.PROSPERO registration numberCRD42016051261.

scholarly journals Sensitivity and Specificity of Electrocardiographic Criteria for Left Ventricular Hypertrophy in Children with Rheumatic Heart Disease

2019 ◽  
Vol 31 (9-10) ◽  
pp. 233-44 ◽  
Author(s):  
Sudigdo Sastroasmoro ◽  
Bambang Madiyono ◽  
Ismet N. Oesman
Keyword(s):  
Heart Disease ◽  
Left Ventricular Hypertrophy ◽  
Confidence Interval ◽  
Rheumatic Heart Disease ◽  
Ventricular Hypertrophy ◽  
Pediatric Patients ◽  
High Specificity ◽  
Left Ventricular ◽  
Diagnostic Modality ◽  
Rheumatic Heart

Electrocardiographic criteria for left ventricular hypertrophy (L VH) were examined in 84 unselected pediatric patients with rheumatic heart disease. There were 47 male and 3 7 female patients, ranging in age from 6 to 19 years. Electrocardiographic L VH was detected m 41 patients (48.8%), i.e. in 55.3% (26/47) of boys and in 36.6% (15/41) of girls. Echocardiographically determined L VH was present in 42 cases (50%) if left ventricular mass (L VM) was indexed for height, or 47 cases (56%) if L VM was indexed for body surface area (BSA). The overall sensitivity of height-indexed electrocardiographic diagnosis of LVH was 71.4% (95% confidence interval= 57.7% to 85.1%), while its sensitivity was 73.8% (95% confidence interval= 60.0% to 87.0%). For BSA indexed echocardiographic LVH, the sensitivity was 68.1% (95% confidence interval = 54.8 to 81.4%) and the specificity was 75.7% (95% confidence interval = 61.9% to 89.5%). When sex-adjustment was examined, there was no increase of sensitivity of electrocardiographic LVH. Sensitivity of the electrocardiogram for LVH increased when age-adjustment was examined with 13 years of age as a cut-off point, both for height indexed and BSA-indexed echocardiographic LVH. Reasons/or the difference between these findings and the findings in adult patients (remarkably low sensitivity and very high specificity of ECG L VH) were discussed. Electrocardiogram was a moderate diagnostic modality in the detection of L VH in our pediatric patients with rheumatic heart disease. Sex did not influence the sensitivity of ECG L VH, but older age group tended to increase its sensitivity.

scholarly journals Screening for subclinical rheumatic heart disease: Addressing borderline disease in a real-world setting

2021 ◽  
Author(s):  
L D Hunter ◽  
A J K Pecoraro ◽  
A F Doubell ◽  
M J Monaghan ◽  
G W Lloyd ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Rheumatic Heart Disease ◽  
Real World ◽  
Large Scale ◽  
Western Cape ◽  
Mitral Valve Leaflet ◽  
Screening Programs ◽  
Systematic Identification ◽  
Rheumatic Heart

Abstract Introduction The World Heart Federation (WHF) criteria identify a large borderline rheumatic heart disease (RHD) category that has hampered the implementation of population-based screening. Inter-scallop separations (ISS) of the posterior mitral valve leaflet (PMVL), a recently described normal variant of the mitral valve, appears to be an important cause of mild mitral regurgitation (MR) leading to misclassification of cases as WHF ‘borderline RHD’. This study aims to report the findings of the Echo in Africa project (EIA), a large-scale RHD screening project in South Africa and determine what proportion of borderline cases would be re-classified as normal if there were a systematic identification of ISS-related MR. Methods A prospective cross-sectional study of underserved secondary schools in the Western Cape was conducted. Participants underwent a screening study with a handheld (HH) ultrasound device. Children with an abnormal HH study were re-evaluated with a portable laptop echocardiography machine. A mechanistic evaluation was applied in cases with isolated WHF ‘pathological’ MR (WHF ‘borderline RHD’). Results 5255 participants (mean age 15± years) were screened. 3439 (65.8%) were female. 49 cases of WHF ‘definite RHD’ (9.1 cases/1000 [95% CI, 6.8-12.1 cases/1000]) and 104 cases of WHF ‘borderline RHD’ (19.5 cases/1000[95% CI,16.0-23.7 cases/1000]) were identified. ISS-related MR was the underlying mechanism of MR in 48/68 cases classified as WHF ‘borderline RHD’ with isolated WHF ‘pathological’ MR (70.5%). Conclusion In a real-world, large-scale screening project, the adoption of a mechanistic evaluation based on the systematic identification of ISS-related MR markedly reduced the number of WHF ‘screen-positive’ cases misclassified as WHF ‘borderline RHD’. Implementing strategies that reduce this misclassification could reduce the cost- and labour-burden on large scale RHD screening programs.

A focussed single-view hand-held echocardiography protocol for the detection of rheumatic heart disease

2017 ◽  
Vol 28 (1) ◽  
pp. 108-117 ◽  
Author(s):  
Adriana Diamantino ◽  
Andrea Beaton ◽  
Twalib Aliku ◽  
Kaciane Oliveira ◽  
Cassio Oliveira ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mitral Regurgitation ◽  
Negative Predictive Value ◽  
Rheumatic Heart Disease ◽  
Predictive Value ◽  
Aortic Insufficiency ◽  
Single View ◽  
Screening Protocol ◽  
Hand Held Echocardiography ◽  
Rheumatic Heart

AbstractBackgroundEchocardiographic screening represents an opportunity for reduction in the global burden of rheumatic heart disease. A focussed single-view screening protocol could allow for the rapid training of healthcare providers and screening of patients.ObjectiveThe aim of this study was to determine the sensitivity and specificity of a focussed single-view hand-held echocardiographic protocol for the diagnosis of rheumatic heart disease in children.MethodsA total of nine readers were divided into three reading groups; each interpreted 200 hand-held echocardiography studies retrospectively as screen-positive, if mitral regurgitation ⩾1.5 cm and/or any aortic insufficiency were observed, or screen-negative from a pooled study library. The performance of experts receiving focussed hand-held protocols, non-experts receiving focussed hand-held protocols, and experts receiving complete hand-held protocols were determined in comparison with consensus interpretations on fully functional echocardiography machines.ResultsIn all, 587 studies including 76 on definite rheumatic heart disease, 122 on borderline rheumatic heart disease, and 389 on normal cases were available for analysis. The focussed single-view protocol had a sensitivity of 81.1%, specificity of 75.5%, negative predictive value of 88.5%, and a positive predictive value of 63.2%; expert readers had higher specificity (86.1 versus 64.8%, p<0.01) but equal sensitivity. Sensitivity – experts, 96% and non-experts, 95% – and negative predictive value – experts, 99% and non-experts, 98% – were better for definite rheumatic heart disease. False-positive screening studies resulting from erroneous identification of mitral regurgitation and aortic insufficiency colour jets increased with shortened protocols and less experience (p<0.01).ConclusionOur data support a focussed screening protocol limited to parasternal long-axis images. This holds promise in making echocardiographic screening more practical in regions where rheumatic heart disease remains endemic.

scholarly journals A focussed single-view hand-held echocardiography protocol for the detection of rheumatic heart disease – CORRIGENDUM

2017 ◽  
Vol 28 (4) ◽  
pp. 619-619
Author(s):  
Adriana Diamantino ◽  
Andrea Beaton ◽  
Twalib Aliku ◽  
Kaciane Oliveira ◽  
Cassio Oliveira ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Single View ◽  
Hand Held Echocardiography ◽  
Rheumatic Heart

scholarly journals The RECARDINA Study protocol: diagnostic utility of ultra-abbreviated echocardiographic protocol for handheld machines used by non-experts to detect rheumatic heart disease

BMJ Open ◽  
2020 ◽  
Vol 10 (5) ◽  
pp. e037609
Author(s):  
Joshua Reginald Francis ◽  
Helen Fairhurst ◽  
Gillian Whalley ◽  
Alex Kaethner ◽  
Anna Ralph ◽  
...  
Keyword(s):  
Heart Disease ◽  
Diagnostic Accuracy ◽  
Research Ethics ◽  
Health Worker ◽  
Rheumatic Heart Disease ◽  
Sensitivity And Specificity ◽  
Health Research ◽  
Index Test ◽  
Timor Leste ◽  
Rheumatic Heart

IntroductionRheumatic heart disease (RHD) causes significant morbidity and mortality in young people from disadvantaged populations. Early detection through echocardiography screening can facilitate early access to treatment. Large-scale implementation of screening could be feasible with the combination of inexpensive standalone ultrasound transducers and upskilling non-expert practitioners to perform abbreviated echocardiography.Methods and analysisA prospective cross-sectional study will evaluate an abbreviated echocardiography screening protocol for the detection of latent (asymptomatic) RHD in high-risk populations. The study will evaluate the diagnostic accuracy of health worker conducted single parasternal long axis view with a sweep using handheld devices (SPLASH) (Philips Lumify S4-1 phased array transducer). Each participant will have at least one reference test performed on the same day by an expert echocardiographer. Diagnosis of RHD will be determined by a panel of three experts, using 2012 World Heart Federation criteria. Sensitivity and specificity of the index test will be calculated with 95% CIs, to determine diagnostic accuracy of a screen-and-refer approach to echocardiography screening for RHD. Remote review of SPLASH images obtained by health workers will facilitate evaluation of the sensitivity and specificity of an alternative approach, using external review of health worker obtained SPLASH images to decide onward referral.Ethics and disseminationEthics approval was obtained from the Human Research Ethics Committee of the Northern Territory Department of Health and Menzies School of Health Research, for the project to be carried out in Timor-Leste (HREC 2019-3399), and in Australia, following review by the Aboriginal Ethics subcommittee (HREC 2019-334). Ethical and technical approval was granted in Timor-Leste, by the Institute National of Health Research Ethics and Technical Committee (1073-MS-INS/GDE/VII/2019). Study results will be disseminated in the communities involved in the study, and through peer-reviewed publications and conference abstracts.Trial registration numberThe Australia New Zealand Clinical Trials Registry (ACTRN12620000122954).

Abstract 11138: Simplified Rheumatic Heart Disease Screening Criteria for Handheld Echocardiography

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Jimmy C Lu ◽  
Craig Sable ◽  
Gregory J Ensing ◽  
Catherine C Webb ◽  
Janet Scheel ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Sensitivity And Specificity ◽  
Continuous Wave ◽  
Aortic Insufficiency ◽  
Screening Strategy ◽  
Lower Sensitivity ◽  
Characteristic Analysis ◽  
Jet Length ◽  
Rheumatic Heart

Background: Using 2012 World Heart Federation (WHF) criteria, standard portable echocardiography (SPE) reveals a high burden of rheumatic heart disease (RHD) in resource poor settings, but widespread screening is limited by cost and physician availability. Handheld echocardiography (HHE) may decrease costs, but WHF criteria are complicated for rapid field screening, particularly for non-physician screeners. Objective: To determine the best simplified screening strategy for RHD detection using HHE. Methods: HHE (GE Vscan) and SPE (GE Vivid q or i or Philips CX-50) were performed in 5 schools in Gulu, Uganda. Borderline or definite RHD cases were defined by 2012 WHF criteria on SPE images, by 2 experienced readers. HHE studies were reviewed by cardiologists blinded to SP results. As HHE lacks continuous wave Doppler, pansystolic mitral regurgitation (MR) was defined as MR on 2 consecutive frames. We evaluated single and combined HHE parameters to determine the simplified screening strategy that maximized sensitivity and specificity for case detection. Results: In 1420 children (10.8±2.6 years old, 47% male) with HHE and SPE studies, morphologic criteria and presence of any MR by HHE had poor specificity (Table). MR jet length by HHE correlated with SPE (r=0.54, p<0.0001). Aortic insufficiency (AI) was specific but not sensitive. Combined criteria of MR jet length ≥1.5 cm, chosen from receiver operating characteristic analysis, or any AI best balanced sensitivity and specificity; pansystolic MR could be substituted for MR jet length with slightly lower sensitivity for definite RHD. With a prevalence of 4% and subsequent SPE screening of positive HHE studies, this would reduce SPE studies by 80% from a SPE-based screening strategy. Conclusions: In resource-limited settings, HHE with simplified criteria offers reasonable sensitivity and specificity for RHD screening. Further study is needed to validate HH screening by local practitioners and long-term outcomes.

scholarly journals Challenges for the Implementation of the First Large-Scale Rheumatic Heart Disease Screening Program in Brazil: The PROVAR Study Experience

2017 ◽  
Author(s):  
Julia Pereira Afonso dos Santos ◽  
Gabriel Assis Lopes do Carmo ◽  
Andrea Zawacki Beaton ◽  
Tainá Vitti Lourenço ◽  
Adriana Costa Diamantino ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Large Scale ◽  
Screening Program ◽  
Disease Screening ◽  
Study Experience ◽  
Rheumatic Heart

scholarly journals Determining the Risk of Developing Rheumatic Heart Disease Following a Negative Screening Echocardiogram

2021 ◽  
Vol 8 ◽  
Author(s):  
Meghan Zimmerman ◽  
Amy Scheel ◽  
Alyssa DeWyer ◽  
Jane-Liz Nambogo ◽  
Isaac Omara Otim ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Large Scale ◽  
Early Stage ◽  
Severe Disease ◽  
Initial Screening ◽  
Screening Programs ◽  
School Based ◽  
Reduced Risk ◽  
Rheumatic Heart

Background: Screening echocardiograms can detect early-stage rheumatic heart disease (RHD), offering a chance to limit progression. Implementation of screening programs is challenging and requires further research. This is the first large-scale study assessing the risk of RHD among previous screen-negative children.Methods: This retrospective cohort study, conducted in Gulu, Uganda, performed school-based echo screening on children ages 5–18 years. Surveys were used to determine which children underwent initial screening 3–5 years prior. Age, gender, and disease severity were compared between cohorts. Relative risk (RR) of RHD was calculated for those with a prior screen-negative echo (exposed cohort) compared to those undergoing first screening (unexposed cohort).Results: Echo screening was completed in 75,708 children; 226 were excluded, leaving 1,582 in the exposed cohort and 73,900 in the unexposed cohort. Prevalence of new RHD was 0.6% (10/1,582) and 1% (737/73,900), in the exposed and unexposed cohorts, respectively. The RR of RHD was 0.64 (95% CI 0.3–1.2, p = 0.15), a nearly 40% reduced risk of RHD in those with a prior negative echo. There was no difference in age or gender between RHD cohorts. All cases in the exposed cohort were borderline/mild; 2.6% of cases in the unexposed cohort had moderate/severe disease.Conclusion: There was no statistical difference in RHD prevalence between previous screen-negative children and children with no prior echocardiogram, however, there was a trend toward decreased risk and severity. This information has important implications for the design of screening programs and the use of screening echocardiograms in endemic RHD regions.

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