Simplified Rheumatic Heart Disease Screening Criteria for Handheld Echocardiography

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

doi:10.1016/j.echo.2015.01.001

Cited by 68 publications

(60 citation statements)

References 12 publications

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“…Bacquelin et al reported a κ value of 0.6 for 2 observers measuring the AMVL in 47 children 25. Lu et al 26 assessed mitral valve thickness in a comparison of handheld versus portable echocardiogram platforms but raw data were not given. Ours is the first study to describe multiple parameters including PMVL normal data and supports the 3 mm WHF cut-off 20 25 26…”

Section: Discussionmentioning

confidence: 99%

Normal echocardiographic mitral and aortic valve thickness in children

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Normal echocardiographic mitral and aortic valve thickness in children

et al. 2017

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“…After the examination was complete, the nurses reported whether the screen was positive or negative. As per previously published recommendations, MR jet ≥1.5 cm measured from the vena contracta to end of the regurgitant jet in any view and/or the presence of any AR in any view was considered a ‘screen positive’ examination, and referral was made for secondary evaluation 11. An independent investigator directly observed 10% of the studies, and recorded the time of HAND acquisition and the total time of the encounter.…”

Section: Methodsmentioning

confidence: 99%

“…However, current diagnostic guidelines provided by the World Heart Federation (WHF) require continuous wave (CW) Doppler, which is not currently available with HAND 10. Recently, Lu et al 11 developed a simplified approach for RHD screening with HAND, which showed high sensitivity for disease detection and reduced the need for STAND evaluation by 80%. Translating this approach to non-experts is essential if widespread adoption of echocardiographic screening is to occur in low-resource areas.…”

Section: Introductionmentioning

confidence: 99%

Handheld echocardiographic screening for rheumatic heart disease by non-experts

Ploutz

Scheel

et al. 2015

Heart

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Objectives Handheld echocardiography (HAND) has good sensitivity and specificity for rheumatic heart disease (RHD) when performed by cardiologists. However, physician shortages in RHD-endemic areas demand less-skilled users to make RHD screening practical. We examine nurse performance and interpretation of HAND using a simplified approach for RHD screening. Methods Two nurses received training on HAND and a simplified screening approach. Consented students at two schools in Uganda were eligible for participation. A simplified approach (HAND performed and interpreted by a non-expert) was compared with the reference standard (standard portable echocardiography, performed and interpreted by experts according to the 2012 World Heart Federation guidelines). Reasons for false-positive and false-negative HAND studies were identified. Results A total of 1002 children were consented, with 956 (11.1 years, 41.8% male) having complete data for review. Diagnoses included: 913 (95.5%) children were classified normal, 32 (3.3%) borderline RHD and 11 (1.2%) definite RHD. The simplified approach had a sensitivity of 74.4% (58.8% to 86.5%) and a specificity of 78.8% (76.0% to 81.4%) for any RHD (borderline and definite). Sensitivity improved to 90.9% (58.7% to 98.5%) for definite RHD. Identification and measurement of erroneous colour jets was the most common reason for false-positive studies (n=164/194), while missed mitral regurgitation and shorter regurgitant jet lengths with HAND were the most common reasons for false-negative studies (n=10/11). Conclusions Non-expert-led HAND screening programmes offer a potential solution to financial and workforce barriers that limit widespread RHD screening. Nurses trained on HAND using a simplified approach had reasonable sensitivity and specificity for RHD screening. Information on reasons for false-negative and false-positive screening studies should be used to inform future training protocols, which could lead to improved screening performance.

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“…MR ≥1.5 cm and/or any aortic insufficiency best balanced sensitivity (73.3%) and specificity (82.4%), with near perfect sensitivity for definite RHD (97.9%) 37. Morphological criteria were neither sensitive nor specific,37 and have shown poor inter-reviewer reliability compared with functional assessment 29 34.…”

Section: Making Echo Screening More Practical and Affordablementioning

confidence: 99%

“…Lu et al then evaluated single and combined simplified criteria through a retrospective review of Ugandan HAND screening studies 29 37. MR ≥1.5 cm and/or any aortic insufficiency best balanced sensitivity (73.3%) and specificity (82.4%), with near perfect sensitivity for definite RHD (97.9%) 37.…”

Section: Making Echo Screening More Practical and Affordablementioning

confidence: 99%

Rheumatic heart disease echocardiographic screening: approaching practical and affordable solutions

Nascimento

Nunes

Lopes

et al. 2016

Heart

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Rheumatic heart disease (RHD) affects at least 32.9 million people worldwide and ranks as a leading cause of death and disability in low-income and middle-income countries (LMICs). Echocardiographic screening has been demonstrated to be a powerful tool for early RHD detection, and holds potential for global RHD control. However, national screening programmes have not emerged. Major barriers to implementation include the lack of human and financial resources in LMICs. Here, we focus on recent research advances that could make echocardiographic screening more practical and affordable, including handheld echocardiography devices, simplified screening protocols and task shifting of echocardiographic screening to non-experts. Additionally, we highlight some important remaining questions before echocardiographic screening can be widely recommended, including demonstration of cost-effectiveness, assessment of the impact of screening on children and communities, and determining the importance of latent RHD. While a single strategy for echocardiographic screening in all high-prevalence areas is unlikely, we believe recent advancements are bringing the public health community closer to developing sustainable programmes for echocardiographic screening.

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Simplified Rheumatic Heart Disease Screening Criteria for Handheld Echocardiography

Cited by 68 publications

References 12 publications

Normal echocardiographic mitral and aortic valve thickness in children

Normal echocardiographic mitral and aortic valve thickness in children

Handheld echocardiographic screening for rheumatic heart disease by non-experts

Rheumatic heart disease echocardiographic screening: approaching practical and affordable solutions

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