Clinical Evaluation Versus Echocardiography in the Assessment of Rheumatic Heart Disease

Abstract

Background: Rheumatic heart disease (RHD) is still a common form of heart disease among children and young adults, especially in developing countries like India. Between 1940 and 1983, the prevalence rate of RHD varied from 1.8 to 11 per 1000 (national average 6 per 1000), while between 1984 and 1995 the rate varied from 1 to 5.4 per 1000 [1]. The study was carried out to assess the accuracy of a medical student's clinical evaluation of valvular heart disease and compare it with that of an echocardiographic evaluation and to determine the sensitivity, specificity and predictive values of clinical examination as compared to echocardiography for the various lesions in RHD patients. Method: 50 children between the ages of 5-16 years, attending the out patient department or admitted in a large teaching hospital, satisfying the criteria of RHD, were included in the study. Each patient underwent detailed clinical evaluation and relevant investigations including echocardiography. Results: Mitral valve was involved most often both by echocardiography and clinically. Isolated aortic valve involvement was rare. The most common lesion was mitral regurgitation (MR) both by auscultation and by echo. Mixed lesions were seen more often than pure lesions. Mitral stenosis (MS) had the highest sensitivity while tricuspid regurgitation (TR) had the highest specificity. MR had the highest positive predictive value and MS the highest negative predictive value. Sensitivity and specificity of aortic regurgitation (AR) was very low when compared to earlier studies. There was a statistically significant difference between echo diagnosis and clinical diagnosis (p < 0.05). Conclusion: It is recommended that echocardiography be done routinely for the diagnosis of cardiac lesions in patients of RHD as clinical examination alone can miss various lesions, especially when the lesions are mild or when multiple lesions are present.

The clinical utility of echocardiography as a cardiological diagnostic tool in poor resource settings

“…The high specificity indicates the ease of clinical diagnosis when signs are florid. Kolo et al [8] in their study also reported the confirmation by In contrast, the sensitivity of clinical examination for RHD was particular low and corroborated the findings by Kolo et al [8] and Reddy et al [16] Specificity was, however, high. More cases were detected at echocardiography in this study for which the indication for the study was initially different.…”

Clinical accuracy of post graduate student in diagnosing congenital heart diseases (CHD) using an algorithmic approach and its comparison with echocardiography

“…We conducted this study to assess the accuracy of clinical diagnosis of congenital heart diseases made by the post graduate student by comparing it with echocardiography. Various studies have been done in children and adults where clinical judgment was compared with the echocardiography for diagnosis of various cardiac disorders [12,13,14,15]. We studied80 cases ofcongenital heart diseases from 1 month to 12 years of age.…”

Echocardiography Screening for Latent Rheumatic Heart Disease: What Can We Do in Indonesia?

“…The simplified echocardiography scoring system to diagnose RHD introduced by Nunes et al offered a more practical and simpler criterion and is suitable for handheld echocardiography application (10). The accuracy of echocardiographic examination even by a handheld echocardiography tool was significantly better than cardiac auscultation alone (1,16,22,23). Most of the RHD screening programs utilized portable echocardiography for more comfortable mobility in remote areas, and in general, they showed a reasonable value for RHD screening.…”