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 Standard echocardiography versus handheld echocardiography for the detection of subclinical rheumatic heart disease: a systematic review and meta-analysis of diagnostic accuracy

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e038449
Author(s):  
Lisa Helen Telford ◽  
Leila Hussein Abdullahi ◽  
Eleanor Atieno Ochodo ◽  
Liesl Joanna Zuhlke ◽  
Mark Emmanuel Engel
Keyword(s):  
Systematic Review ◽  
Heart Disease ◽  
Diagnostic Accuracy ◽  
Receiver Operating Characteristic ◽  
Rheumatic Heart Disease ◽  
Operating Characteristic ◽  
Meta Analysis ◽  
Endemic Areas ◽  
Rheumatic Heart ◽  
Receiver Operating

ObjectiveTo summarise the accuracy of handheld echocardiography (HAND) which, if shown to be sufficiently similar to that of standard echocardiography (STAND), could usher in a new age of rheumatic heart disease (RHD) screening in endemic areas.DesignSystematic review and meta-analysis.Data sourcesPubMed, Scopus, EBSCOHost and ISI Web of Science were initially searched on 27 September 2017 and again on 3 March 2020 for studies published from 2012 onwards.Eligibility criteriaStudies assessing the accuracy of HAND compared with STAND when performed by an experienced cardiologist in conjunction with the 2012 World Heart Federation criteria among populations of children and adolescents living in endemic areas were included.Data extraction and synthesisTwo reviewers independently extracted data and assessed the methodological quality of included studies against review-specific Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 criteria. A meta-analysis using the hierarchical summary receiver operating characteristic model was conducted to produce summary results of sensitivity and specificity. Forest plots and scatter plots in receiver operating characteristic space in combination with subgroup analyses were used to investigate heterogeneity. Publication bias was not investigated.ResultsSix studies (N=4208) were included in the analysis. For any RHD detection, the pooled results from six studies were as follows: sensitivity: 81.56% (95% CI 76.52% to 86.61%) and specificity: 89.75% (84.48% to 95.01%). Meta-analytical results from five of the six included studies were as follows: sensitivity: 91.06% (80.46% to 100%) and specificity: 91.96% (85.57% to 98.36%) for the detection of definite RHD only and sensitivity: 62.01% (31.80% to 92.22%) and specificity: 82.33% (65.15% to 99.52%) for the detection of borderline RHD only.ConclusionsHAND displayed good accuracy for detecting definite RHD only and modest accuracy for detecting any RHD but demonstrated poor accuracy for the detection of borderline RHD alone. Findings from this review provide some evidence for the potential of HAND to increase access to echocardiographic screening for RHD in resource-limited and remote settings; however, further research into feasibility and cost-effectiveness of wide-scale screening is still needed.PROSPERO registration numberCRD42016051261.

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 Prevalence of rheumatic heart disease among school children in East Africa: a systematic review and meta-analysis

2021 ◽  
Vol 38 ◽  
Author(s):  
Melaku Bimerew ◽  
Biruk Beletew ◽  
Addisu Getie ◽  
Adam Wondmieneh ◽  
Getnet Gedefaw ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heart Disease ◽  
East Africa ◽  
Rheumatic Heart Disease ◽  
School Children ◽  
Meta Analysis ◽  
Rheumatic Heart

scholarly journals Integrating the Prevention and Control of Rheumatic Heart Disease into Country Health Systems: A Systematic Review and Meta-Analysis

Global Heart ◽  
2020 ◽  
Vol 15 (1) ◽  
pp. 62
Author(s):  
Jessica Abrams ◽  
David A. Watkins ◽  
Leila H. Abdullahi ◽  
Liesl J. Zühlke ◽  
Mark E. Engel
Keyword(s):  
Systematic Review ◽  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Health Systems ◽  
Prevention And Control ◽  
Meta Analysis ◽  
And Control ◽  
Rheumatic Heart

scholarly journals Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents

2014 ◽  
Vol 2 (12) ◽  
pp. e717-e726 ◽  
Author(s):  
Martina Rothenbühler ◽  
Crochan J O'Sullivan ◽  
Stefan Stortecky ◽  
Giulio G Stefanini ◽  
Ernest Spitzer ◽  
...  
Keyword(s):  
Systematic Review ◽  
Heart Disease ◽  
Children And Adolescents ◽  
Rheumatic Heart Disease ◽  
Active Surveillance ◽  
Meta Analysis ◽  
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).

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