Abstract 11138: Simplified Rheumatic Heart Disease Screening Criteria for Handheld Echocardiography
Background: Using 2012 World Heart Federation (WHF) criteria, standard portable echocardiography (SPE) 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 (HHE) may decrease costs, but WHF criteria are complicated for rapid field screening, particularly for non-physician screeners.
Objective: To determine the best simplified screening strategy for RHD detection using HHE.
Methods: HHE (GE Vscan) and SPE (GE Vivid q or i or Philips CX-50) were performed in 5 schools in Gulu, Uganda. Borderline or definite RHD cases were defined by 2012 WHF criteria on SPE images, by 2 experienced readers. HHE studies were reviewed by cardiologists blinded to SP results. As HHE lacks continuous wave Doppler, pansystolic mitral regurgitation (MR) was defined as MR on 2 consecutive frames. We evaluated single and combined HHE parameters to determine the simplified screening strategy that maximized sensitivity and specificity for case detection.
Results: In 1420 children (10.8±2.6 years old, 47% male) with HHE and SPE studies, morphologic criteria and presence of any MR by HHE had poor specificity (Table). MR jet length by HHE correlated with SPE (r=0.54, p<0.0001). Aortic insufficiency (AI) was specific but not sensitive. Combined criteria of MR jet length ≥1.5 cm, chosen from receiver operating characteristic analysis, or any AI best balanced sensitivity and specificity; pansystolic MR could be substituted for MR jet length with slightly lower sensitivity for definite RHD. With a prevalence of 4% and subsequent SPE screening of positive HHE studies, this would reduce SPE studies by 80% from a SPE-based screening strategy.
Conclusions: In resource-limited settings, HHE with simplified criteria offers reasonable sensitivity and specificity for RHD screening. Further study is needed to validate HH screening by local practitioners and long-term outcomes.
Author Disclosures: J.C. Lu: None. C. Sable: None. G.J. Ensing: None. C.C. Webb: None. J. Scheel: None. T. Aliku: None. J.C. Godown: None. A. Beaton: None.
- © 2014 by American Heart Association, Inc.