Assessing The Performance Characteristics of Handheld Ultrasound In A Rheumatic Heart Disease Screening Program

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 pilot 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 that screening echocardiograms for RHD may yield different results when a handheld ultrasound device is used.

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

10.21203/rs.3.rs-580374/v1 ◽

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.

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Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study

Journal of the American Heart Association ◽

10.1161/jaha.117.008039 ◽

2018 ◽

Vol 7 (4) ◽

Cited By ~ 16

Author(s):

Bruno R. Nascimento ◽

Craig Sable ◽

Maria Carmo P. Nunes ◽

Adriana C. Diamantino ◽

Kaciane K. B. Oliveira ◽

...

Keyword(s):

Heart Disease ◽

Rheumatic Heart Disease ◽

Screening Program ◽

Disease Screening ◽

Valve Disease ◽

Rheumatic Valve Disease ◽

Rheumatic Heart

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

Arquivos Brasileiros de Cardiologia ◽

10.5935/abc.20170047 ◽

2017 ◽

Cited By ~ 1

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

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Single-View Echocardiography by Nonexpert Practitioners to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy

Circulation Cardiovascular Imaging ◽

10.1161/circimaging.120.011790 ◽

2021 ◽

Author(s):

Joshua R. Francis ◽

Gillian A. Whalley ◽

Alex Kaethner ◽

Helen Fairhurst ◽

Hilary Hardefeldt ◽

...

Keyword(s):

Heart Disease ◽

Diagnostic Accuracy ◽

Rheumatic Heart Disease ◽

Index Test ◽

Reference Test ◽

Ultrasound Device ◽

Specificity And Sensitivity ◽

Handheld Ultrasound ◽

Rheumatic Heart ◽

Axis View

Background: Echocardiographic screening can detect asymptomatic cases of rheumatic heart disease (RHD), facilitating access to treatment. Barriers to implementation of echocardiographic screening include the requirement for expensive equipment and expert practitioners. We aimed to evaluate the diagnostic accuracy of an abbreviated echocardiographic screening protocol (single parasternal-long-axis view with a sweep of the heart) performed by briefly trained, nonexpert practitioners using handheld ultrasound devices. Methods: Participants aged 5 to 20 years in Timor-Leste and the Northern Territory of Australia had 2 echocardiograms: one performed by an expert echocardiographer using a GE Vivid I or Vivid Q portable ultrasound device (reference test), and one performed by a nonexpert practitioner using a GE Vscan handheld ultrasound device (index test). The accuracy of the index test, compared with the reference test, for identifying cases with definite or borderline RHD was determined. Results: There were 3111 enrolled participants; 2573 had both an index test and reference test. Median age was 12 years (interquartile range, 10–15); 58.2% were female. Proportion with definite or borderline RHD was 5.52% (95% CI, 4.70–6.47); proportion with definite RHD was 3.23% (95% CI, 2.61–3.98). Compared with the reference test, sensitivity of the index test for definite or borderline RHD was 70.4% (95% CI, 62.2–77.8), specificity was 78.1% (95% CI, 76.4–79.8). Conclusions: Nonexpert practitioners can be trained to perform single parasternal-long-axis view with a sweep of the heart echocardiography. However, the specificity and sensitivity are inadequate for echocardiographic screening. Improved training for nonexpert practitioners should be investigated.

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