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

Echocardiographic screening of pregnant women by non-physicians with remote interpretation in primary care

2020 ◽  
Author(s):  
Bruno R Nascimento ◽  
Craig Sable ◽  
Maria Carmo P Nunes ◽  
Kaciane K B Oliveira ◽  
Juliane Franco ◽  
...  
Keyword(s):  
Primary Care ◽  
Heart Disease ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Pregnant Women ◽  
Rheumatic Heart Disease ◽  
Morphological Changes ◽  
Severe Disease ◽  
Left Ventricular ◽  
Rheumatic Heart

Abstract Background Impact of heart disease (HD) on pregnancy is significant. Objective We aimed to evaluate the feasibility of integrating screening echocardiography (echo) into the Brazilian prenatal primary care to assess HD prevalence. Methods Over 13 months, 20 healthcare workers acquired simplified echo protocols, utilizing hand-held machines (GE-VSCAN), in 22 primary care centres. Consecutive pregnant women unaware of HD underwent focused echo, remotely interpreted in USA and Brazil. Major HD was defined as structural valve abnormalities, more than mild valve dysfunction, ventricular systolic dysfunction/hypertrophy, or other major abnormalities. Screen-positive women were referred for standard echo. Results At total, 1 112 women underwent screening. Mean age was 27 ± 8 years, mean gestational age 22 ± 9 weeks. Major HD was found in 100 (9.0%) patients. More than mild mitral regurgitation was observed in 47 (4.2%), tricuspid regurgitation in 11 (1.0%), mild left ventricular dysfunction in 4 (0.4%), left ventricular hypertrophy in 2 (0.2%) and suspected rheumatic heart disease in 36 (3.2%): all, with mitral valve and two with aortic valve (AV) involvement. Other AV disease was observed in 11 (10%). In 56 screen-positive women undergoing standard echo, major HD was confirmed in 45 (80.4%): RHD findings in 12 patients (all with mitral valve and two with AV disease), mitral regurgitation in 40 (14 with morphological changes, 10 suggestive of rheumatic heart disease), other AV disease in two (mild/moderate regurgitation). Conclusions Integration of echo screening into primary prenatal care is feasible in Brazil. However, the low prevalence of severe disease urges further investigations about the effectiveness of the strategy.

scholarly journals Assessing The Performance Characteristics of Handheld Ultrasound in A Rheumatic Heart Disease Screening Program

2021 ◽  
Author(s):  
Zachary P. Kaltenborn ◽  
Zewde. Anteneh ◽  
Jonathan D. Kirsch ◽  
Michelle Yates ◽  
Katelyn M. Tessier ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Screening Program ◽  
P Value ◽  
Portable Ultrasound ◽  
Single View ◽  
Expert Review ◽  
Ultrasound Device ◽  
Handheld Ultrasound ◽  
Rheumatic Heart

Abstract Background Rheumatic heart disease affects 33 million people in low and middle income countries and is the leading cause of cardiovascular death among children and young adults. Penicillin prophylaxis has been shown to improve valvular function among patients with clinically silent or mild disease. Efforts to expand echocardiographic screening are focusing on simplified protocols, non-physician ultrasonographers, and portable ultrasound devices, including handheld ultrasound. Recent advances support the use of single-view screening protocols. With the increasing availability and low cost of handheld devices, prospective studies are needed to evaluate their performance in these settings. Methods We conducted a cross-sectional study among 19 at-risk school-children participating in a rheumatic heart disease screening program in Ethiopia comparing a handheld ultrasound device (Phillips Lumify) to a fully-equipped portable ultrasound machine (Sonosite M-Turbo). Results Agreement between devices was similar for expert and non-expert review (84%). However, when reviewed by a non-expert the Lumify identified fewer screen-positive cases (p-value 0.083). We also compared non-expert to expert interpretation by device and found a significant difference in interpretation for the Lumify (p-value 0.025). There was a trend towards shorter jet length by color Doppler in the handheld ultrasound device for both expert and non-expert review. Conclusions Our study highlights the importance of using caution when applying proposed single-view criteria as the sensitivity and specificity may be affected by the device.

A rapid echocardiographic screening protocol for rheumatic heart disease in Samoa: a high prevalence of advanced disease

2017 ◽  
Vol 27 (8) ◽  
pp. 1599-1605 ◽  
Author(s):  
Marvin Allen ◽  
John Allen ◽  
Take Naseri ◽  
Rebecca Gardner ◽  
Dennis Tolley ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Advanced Disease ◽  
Valve Disease ◽  
Severe Aortic Regurgitation ◽  
Time Period ◽  
High Prevalence ◽  
The World ◽  
Screening Protocol ◽  
Rheumatic Heart

AbstractBackgroundEchocardiography has been proposed as a method to screen children for rheumatic heart disease. The World Heart Federation has established guidelines for echocardiographic screening. In this study, we describe a rapid echocardiogram screening protocol according to the World Heart Federation guidelines in Samoa, endemic for rheumatic heart disease.MethodsWe performed echocardiogram screening in schoolchildren in Samoa between 2013 and 2015. A brief screening echocardiogram was performed on all students. Children with predefined criteria suspicious for rheumatic hear diseases were referred for a more comprehensive echocardiogram. Complete echocardiograms were classified according to the World Heart Federation guidelines and severity of valve disease.ResultsEchocardiographic screening was performed on 11,434 children, with a mean age of 10.2 years; 51% of them were females. A total of 558 (4.8%) children underwent comprehensive echocardiography, including 49 students who were randomly selected as controls. Definite rheumatic heart disease was observed in 115 students (10.0 per 1000): 92 students were classified as borderline (8.0 per 1000) and 23 with CHD. Advanced disease was identified in 50 students (4.4 per 1000): 15 with severe mitral regurgitation, five with severe aortic regurgitation, 11 with mitral stenoses, and 19 with mitral and aortic valve disease.ConclusionsWe successfully applied a rapid echocardiographic screening protocol to a large number of students over a short time period – 28 days of screening over a 3-year time period – to identify a high prevalence of rheumatic heart disease. We also reported a significantly higher rate of advanced disease compared with previously published echocardiographic screening programmes.

Penicillin and Acute Rheumatic Fever

PEDIATRICS ◽  
1982 ◽  
Vol 70 (3) ◽  
pp. 506-507
Author(s):  
Bernard Boxerbaum
Keyword(s):  
Heart Disease ◽  
Mitral Regurgitation ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Acute Rheumatic Fever ◽  
Secondary Prophylaxis ◽  
Benzathine Penicillin ◽  
Childrens Hospital ◽  
Rheumatic Heart

Introduction of secondary prophylaxis for patients with rheumatic fever is felt to be a major reason for improved prognosis of rheumatic heart disease.1,2(p163) The article by Ginsburg et al,3 raising questions concerning the efficacy of this practice, has prompted me to report our experience in the Rainbow Rheumatic Fever Clinic, Rainbow Babies and Childrens Hospital, where more than 80% of the patients receive 1,200,000 units of benzathine penicillin intramuscularly every 28 days. Seventy percent of the patients with rheumatic mitral regurgitation have lost their murmur, and no patient receiving regular intramuscular prophylaxis has developed stenosis.4

Sign in / Sign up

Export Citation Format

Share Document