Rachel H Webb1, Tom L Gentles2, John W Stirling2, Mildred Lee2, Clare O'Donnell2, Nigel J Wilson2. 1. Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand. Electronic address: rwebb@adhb.govt.nz. 2. Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.
Abstract
BACKGROUND: There is increasing use of portable echocardiography as a screening test for rheumatic heart disease (RHD). The prevalence of valvular regurgitation in healthy populations as determined using portable echocardiography has not been well defined. Minimal echocardiographic criteria for RHD have recently been clarified, but the overlap of normal and abnormal valvular regurgitation warrants further study. The aim of this study was to determine the spectrum of echocardiographic findings using portable echocardiography in children from a population with low prevalence of RHD. METHODS: Screening echocardiography was conducted in 396 healthy students aged 10 to 12 years using portable echocardiographic equipment. Echocardiograms were assessed according to 2012 World Heart Federation criteria for RHD. The prevalence of physiologic valvular regurgitation was compared with that found in previous studies of children using large-platform machines. RESULTS: Physiologic mitral regurgitation (MR) was present in 14.9% of subjects (95% CI, 11.7%-18.7%) and pathologic MR in 1.3% (95% CI, 0.6%-2.9%). Two percent (95% CI, 1.0%-3.9%) had physiologic aortic regurgitation, and none had pathologic aortic valve regurgitation. Physiologic tricuspid regurgitation was present in 72.7% of subjects (95% CI, 68.1%-76.9%) and physiologic pulmonary regurgitation in 89.6% (95% CI, 85.7%-91.8%). After cardiology review, no cases of definite RHD were found, but 0.5% of patients (95% CI, 0.1%-1.8%) had pathologic MR meeting World Heart Federation criteria for borderline RHD. Two percent (95% CI, 1.4%-4.6%) of the cohort had minor forms of congenital heart disease. CONCLUSIONS: The spectrum of physiologic cardiac valvular regurgitation in healthy children as determined using portable echocardiography is described and is within the range of previous studies using large-platform echocardiographic equipment. The finding of two children with pathologic-grade MR, likely representing the upper limit of physiologic regurgitation, has implications for echocardiographic screening for RHD in high-prevalence regions.
BACKGROUND: There is increasing use of portable echocardiography as a screening test for rheumatic heart disease (RHD). The prevalence of valvular regurgitation in healthy populations as determined using portable echocardiography has not been well defined. Minimal echocardiographic criteria for RHD have recently been clarified, but the overlap of normal and abnormal valvular regurgitation warrants further study. The aim of this study was to determine the spectrum of echocardiographic findings using portable echocardiography in children from a population with low prevalence of RHD. METHODS: Screening echocardiography was conducted in 396 healthy students aged 10 to 12 years using portable echocardiographic equipment. Echocardiograms were assessed according to 2012 World Heart Federation criteria for RHD. The prevalence of physiologic valvular regurgitation was compared with that found in previous studies of children using large-platform machines. RESULTS: Physiologic mitral regurgitation (MR) was present in 14.9% of subjects (95% CI, 11.7%-18.7%) and pathologic MR in 1.3% (95% CI, 0.6%-2.9%). Two percent (95% CI, 1.0%-3.9%) had physiologic aortic regurgitation, and none had pathologic aortic valve regurgitation. Physiologic tricuspid regurgitation was present in 72.7% of subjects (95% CI, 68.1%-76.9%) and physiologic pulmonary regurgitation in 89.6% (95% CI, 85.7%-91.8%). After cardiology review, no cases of definite RHD were found, but 0.5% of patients (95% CI, 0.1%-1.8%) had pathologic MR meeting World Heart Federation criteria for borderline RHD. Two percent (95% CI, 1.4%-4.6%) of the cohort had minor forms of congenital heart disease. CONCLUSIONS: The spectrum of physiologic cardiac valvular regurgitation in healthy children as determined using portable echocardiography is described and is within the range of previous studies using large-platform echocardiographic equipment. The finding of two children with pathologic-grade MR, likely representing the upper limit of physiologic regurgitation, has implications for echocardiographic screening for RHD in high-prevalence regions.
Authors: Jennifer H Huang; Michael Favazza; Arthur Legg; Kathryn W Holmes; Laurie Armsby; Ipuniuesea Eliapo-Unutoa; Thomas Pilgrim; Erin J Madriago Journal: Pediatr Cardiol Date: 2017-09-20 Impact factor: 1.655
Authors: Bo Remenyi; Jonathan Carapetis; John W Stirling; Beatrice Ferreira; Krishnan Kumar; John Lawrenson; Eloi Marijon; Mariana Mirabel; A O Mocumbi; Cleonice Mota; John Paar; Anita Saxena; Janet Scheel; Satu Viali; I B Vijayalakshmi; Gavin R Wheaton; Liesl Zuhlke; Karishma Sidhu; Eliazar Dimalapang; Thomas L Gentles; Nigel J Wilson Journal: Heart Asia Date: 2019-06-24
Authors: Zachary W Binder; Sharon E O'Brien; Tehnaz P Boyle; Howard J Cabral; Sepehr Sekhavat; Joseph R Pare Journal: West J Emerg Med Date: 2020-06-24
Authors: Daniel Engelman; Joseph H Kado; Bo Reményi; Samantha M Colquhoun; Jonathan R Carapetis; Nigel J Wilson; Susan Donath; Andrew C Steer Journal: BMC Cardiovasc Disord Date: 2016-02-01 Impact factor: 2.298
Authors: Luke David Hunter; Mark Monaghan; Guy Lloyd; Carl Lombard; Alfonso Jan Kemp Pecoraro; Anton Frans Doubell; Philipus George Herbst Journal: Open Heart Date: 2020-11
Authors: Wyman W Lai; Bradley S Galer; Pierre C Wong; Gail Farfel; Milka Pringsheim; Martin G Keane; Anupam Agarwal Journal: Epilepsia Date: 2020-08-18 Impact factor: 5.864