Abstract 11256: Handheld Echocardiography Improves Detection of Rheumatic Heart Disease in Ugandan Schoolchildren Compared to Auscultation
Background: Rheumatic heart disease (RHD) remains a major public health concern in developing countries and routine screening has the potential to improve outcomes. Standard portable echocardiography (SPE) is far more sensitive than auscultation for the detection of RHD, but remains cost-prohibitive in resource-limited settings. With its lower cost, handheld echocardiography (HHE) has the potential to fill this void. The purpose of this study was to assess the incremental value of HHE over auscultation to identify RHD, as compared to SPE.
Methods: Over 1 week, children at 5 schools in Gulu, Uganda underwent focused SPE (parasternal and apical views). Any child with mitral or aortic regurgitation or stenosis, plus a randomly selected group of children with normal SPE findings underwent HHE by echocardiographers and auscultation by a local physician. SPE and HHE studies were interpreted blindly using the 2012 World Heart Federation criteria by 6 experienced cardiologists. A second reader confirmed any study with borderline or definite RHD, with discrepancies resolved by a third reader. Sensitivity and specificity of HHE and auscultation for the detection of any RHD, definite RHD, and pathologic mitral or aortic regurgitation were calculated using SPE as the gold standard.
Results: Of 4,773 children who underwent screening with SPE, a subgroup of 1,317 children (46 % male, 10.8 ± 2.6 years of age) underwent HHE and auscultation. Auscultation had uniformly poor sensitivity to detect RHD or valve disease. Sensitivity was significantly improved using HHE compared to auscultation for the detection of definite RHD (97.8% vs 22.2%), borderline or definite RHD (78.4% vs 16.4%), and pathologic aortic insufficiency (81.8% vs 13.6%) (Table).
Conclusions: Auscultation is a poor screening test for the detection of RHD. HHE significantly improves detection of RHD and may be a useful adjunct to or replacement of auscultation in resource-limited settings.
Author Disclosures: J. Godown: None. J.C. Lu: None. A. Beaton: None. C. Sable: None. G. Mirembe: None. R. Sanya: None. T. Aliku: None. S. Yu: None. G.J. Ensing: None.
- © 2014 by American Heart Association, Inc.