Mariana Mirabel1, Raoul Bacquelin2, Muriel Tafflet2, Corinne Robillard2, Bertrand Huon2, Philippe Corsenac2, Isabelle de Frémicourt2, Kumar Narayanan2, Jean-Michel Meunier2, Baptiste Noël2, Albert Alain Hagège2, Bernard Rouchon2, Xavier Jouven2, Eloi Marijon2. 1. From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.). mariana.mirabel@inserm.fr. 2. From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
Abstract
BACKGROUND: Rheumatic heart disease (RHD) remains a major public health problem worldwide. Although early diagnosis by echocardiography may potentially play a key role in developing active surveillance, systematic evaluation of simple approaches in resource poor settings are needed. METHODS AND RESULTS: We prospectively compared focused cardiac ultrasound (FCU) to a reference approach for RHD screening in a school children population. FCU included (1) the use of a pocket-sized echocardiography machine, (2) nonexpert staff (2 nurses with specific training), and (3) a simplified set of echocardiographic criteria. The reference approach used standardized echocardiographic examination, reviewed by an expert cardiologist, according to 2012 World Heart Federation criteria. Among the 6 different echocardiographic criteria, first tested in a preliminary phase, mitral regurgitation jet length≥2 cm or any aortic regurgitation was considered best suited to be FCU criteria. Of the 1217 subjects enrolled (mean, 9.6±1 years; 49.6% male), 49 (4%) were diagnosed with RHD by the reference approach. The sensitivity of FCU for the detection of RHD was 83.7% (95% confidence interval, 73.3-94.0) for nurse A and 77.6% (95% confidence interval, 65.9-89.2) for nurse B. FCU yielded a specificity of 90.9% (95% confidence interval, 89.3-92.6) and 92.0% (95% confidence interval, 90.4-93.5) according to users. Percentage of agreement among nurses was 91.4%. CONCLUSIONS: FCU by nonexperts using pocket devices seems feasible and yields acceptable sensitivity and specificity for RHD detection when compared with the state-of-the-art approach, thereby opening new perspectives for mass screening for RHD in low-resource settings.
BACKGROUND:Rheumatic heart disease (RHD) remains a major public health problem worldwide. Although early diagnosis by echocardiography may potentially play a key role in developing active surveillance, systematic evaluation of simple approaches in resource poor settings are needed. METHODS AND RESULTS: We prospectively compared focused cardiac ultrasound (FCU) to a reference approach for RHD screening in a school children population. FCU included (1) the use of a pocket-sized echocardiography machine, (2) nonexpert staff (2 nurses with specific training), and (3) a simplified set of echocardiographic criteria. The reference approach used standardized echocardiographic examination, reviewed by an expert cardiologist, according to 2012 World Heart Federation criteria. Among the 6 different echocardiographic criteria, first tested in a preliminary phase, mitral regurgitation jet length≥2 cm or any aortic regurgitation was considered best suited to be FCU criteria. Of the 1217 subjects enrolled (mean, 9.6±1 years; 49.6% male), 49 (4%) were diagnosed with RHD by the reference approach. The sensitivity of FCU for the detection of RHD was 83.7% (95% confidence interval, 73.3-94.0) for nurse A and 77.6% (95% confidence interval, 65.9-89.2) for nurse B. FCU yielded a specificity of 90.9% (95% confidence interval, 89.3-92.6) and 92.0% (95% confidence interval, 90.4-93.5) according to users. Percentage of agreement among nurses was 91.4%. CONCLUSIONS:FCU by nonexperts using pocket devices seems feasible and yields acceptable sensitivity and specificity for RHD detection when compared with the state-of-the-art approach, thereby opening new perspectives for mass screening for RHD in low-resource settings.
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