Simplified rheumatic heart disease screening criteria for handheld echocardiography

Jimmy C Lu; Craig Sable; Gregory J Ensing; Catherine Webb; Janet Scheel; Twalib Aliku; Peter Lwabi; Justin Godown; Andrea Beaton

doi:10.1016/j.echo.2015.01.001

Simplified rheumatic heart disease screening criteria for handheld echocardiography

J Am Soc Echocardiogr. 2015 Apr;28(4):463-9. doi: 10.1016/j.echo.2015.01.001. Epub 2015 Feb 7.

Authors

Jimmy C Lu¹, Craig Sable², Gregory J Ensing³, Catherine Webb³, Janet Scheel², Twalib Aliku⁴, Peter Lwabi⁴, Justin Godown⁵, Andrea Beaton²

Affiliations

¹ University of Michigan Congenital Heart Center, Ann Arbor, Michigan. Electronic address: jimmyl@umich.edu.
² Children's National Medical Center, Washington, District of Columbia.
³ University of Michigan Congenital Heart Center, Ann Arbor, Michigan.
⁴ Uganda Heart Institute, Kampala, Uganda.
⁵ Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.

PMID: 25660669
DOI: 10.1016/j.echo.2015.01.001

Abstract

Background: Using 2012 World Heart Federation criteria, standard portable echocardiography (STAND) 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 (HAND) may decrease costs, but World Heart Federation criteria are complicated for rapid field screening, particularly for nonphysician screeners. The aim of this study was to determine the best simplified screening strategy for RHD detection using HAND.

Methods: In this prospective study, STAND (GE Vivid q or i or Philips CX-50) was performed in five schools in Gulu, Uganda; a random subset plus all children with detectable mitral regurgitation or aortic insufficiency also underwent HAND (GE Vscan). Borderline or definite RHD cases were defined by 2012 World Heart Federation criteria on STAND images, by two experienced readers. HAND studies were reviewed by cardiologists blinded to STAND results. Single and combined HAND parameters were evaluated to determine the simplified screening strategy that maximized sensitivity and specificity for case detection.

Results: In 1,439 children (mean age, 10.8 ± 2.6 years; 47% male) with HAND and STAND studies, morphologic criteria and the presence of any mitral regurgitation by HAND had poor specificity. The presence of aortic insufficiency was specific but not sensitive. Combined criteria of mitral regurgitation jet length ≥ 1.5 cm or any aortic insufficiency best balanced sensitivity (73.3%) and specificity (82.4%), with excellent sensitivity for definite RHD (97.9%). With a prevalence of 4% and subsequent STAND screening of positive HAND studies, this would reduce STAND studies by 80% from a STAND-based screening strategy.

Conclusions: In resource-limited settings, HAND with simplified criteria can detect RHD with good sensitivity and specificity and decrease the need for standard echocardiography. Further study is needed to validate screening by local practitioners and long-term outcomes.

Keywords: Aortic insufficiency; Handheld echocardiography; Mitral regurgitation; Rheumatic heart disease.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Algorithms*
Child
Echocardiography / instrumentation
Echocardiography / methods*
Female
Heart Valve Diseases / diagnostic imaging*
Humans
Male
Mass Screening / methods*
Miniaturization
Patient Positioning / methods*
Point-of-Care Systems
Reproducibility of Results
Rheumatic Heart Disease / diagnostic imaging*
Sensitivity and Specificity
Uganda

Abstract

Publication types

MeSH terms

Grants and funding