Inter-rater and intra-rater reliability and agreement of echocardiographic diagnosis of rheumatic heart disease using the World Heart Federation evidence-based criteria

ObjectiveDifferent definitions have been used for screening for rheumatic heart disease (RHD). This led to the development of the 2012 evidence-based World Heart Federation (WHF) echocardiographic criteria. The objective of this study is to determine the intra-rater and inter-rater reliability and agreement in differentiating no RHD from mild RHD using the WHF echocardiographic criteria.MethodsA standard set of 200 echocardiograms was collated from prior population-based surveys and uploaded for blinded web-based reporting. Fifteen international cardiologists reported on and categorised each echocardiogram as no RHD, borderline or definite RHD. Intra-rater and inter-rater reliability was calculated using Cohen’s and Fleiss’ free-marginal multirater kappa (κ) statistics, respectively. Agreement assessment was expressed as percentages. Subanalyses assessed reproducibility and agreement parameters in detecting individual components of WHF criteria.ResultsSample size from a statistical standpoint was 3000, based on repeated reporting of the 200 studies. The inter-rater and intra-rater reliability of diagnosing definite RHD was substantial with a kappa of 0.65 and 0.69, respectively. The diagnosis of pathological mitral and aortic regurgitation was reliable and almost perfect, kappa of 0.79 and 0.86, respectively. Agreement for morphological changes of RHD was variable ranging from 0.54 to 0.93 κ.ConclusionsThe WHF echocardiographic criteria enable reproducible categorisation of echocardiograms as definite RHD versus no or borderline RHD and hence it would be a suitable tool for screening and monitoring disease progression. The study highlights the strengths and limitations of the WHF echo criteria and provides a platform for future revisions.

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Contemporary Diagnosis and Management of Rheumatic Heart Disease: Implications for Closing the Gap: A Scientific Statement From the American Heart Association

Circulation ◽

10.1161/cir.0000000000000921 ◽

2020 ◽

Vol 142 (20) ◽

Author(s):

Raman Krishna Kumar ◽

Manuel J. Antunes ◽

Andrea Beaton ◽

Mariana Mirabel ◽

Vuyisile T. Nkomo ◽

...

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Rheumatic Heart Disease ◽

Treatment Options ◽

Heart Association ◽

Population Based ◽

Diagnosis And Treatment ◽

Optimal Care ◽

Percutaneous Balloon ◽

Rheumatic Heart

The global burden of rheumatic heart disease continues to be significant although it is largely limited to poor and marginalized populations. In most endemic regions, affected patients present with heart failure. This statement will seek to examine the current state-of-the-art recommendations and to identify gaps in diagnosis and treatment globally that can inform strategies for reducing disease burden. Echocardiography screening based on World Heart Federation echocardiographic criteria holds promise to identify patients earlier, when prophylaxis is more likely to be effective; however, several important questions need to be answered before this can translate into public policy. Population-based registries effectively enable optimal care and secondary penicillin prophylaxis within available resources. Benzathine penicillin injections remain the cornerstone of secondary prevention. Challenges with penicillin procurement and concern with adverse reactions in patients with advanced disease remain important issues. Heart failure management, prevention, early diagnosis and treatment of endocarditis, oral anticoagulation for atrial fibrillation, and prosthetic valves are vital therapeutic adjuncts. Management of health of women with unoperated and operated rheumatic heart disease before, during, and after pregnancy is a significant challenge that requires a multidisciplinary team effort. Patients with isolated mitral stenosis often benefit from percutaneous balloon mitral valvuloplasty. Timely heart valve surgery can mitigate the progression to heart failure, disability, and death. Valve repair is preferable over replacement for rheumatic mitral regurgitation but is not available to the vast majority of patients in endemic regions. This body of work forms a foundation on which a companion document on advocacy for rheumatic heart disease has been developed. Ultimately, the combination of expanded treatment options, research, and advocacy built on existing knowledge and science provides the best opportunity to address the burden of rheumatic heart disease.

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Rheumatic heart disease burden, trends, and inequalities in the Americas, 1990–2017: a population-based study

The Lancet Global Health ◽

10.1016/s2214-109x(19)30360-2 ◽

2019 ◽

Vol 7 (10) ◽

pp. e1388-e1397 ◽

Cited By ~ 4

Author(s):

Pedro Ordunez ◽

Ramon Martinez ◽

Patricia Soliz ◽

Gloria Giraldo ◽

Oscar J Mujica ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Disease Burden ◽

Population Based ◽

Population Based Study ◽

Rheumatic Heart

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

Family Practice ◽

10.1093/fampra/cmaa115 ◽

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.

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