BACKGROUND: Echocardiographic screening represents an opportunity for reduction in the global burden of rheumatic heart disease. A focussed single-view screening protocol could allow for the rapid training of healthcare providers and screening of patients. OBJECTIVE: The aim of this study was to determine the sensitivity and specificity of a focussed single-view hand-held echocardiographic protocol for the diagnosis of rheumatic heart disease in children. METHODS: A total of nine readers were divided into three reading groups; each interpreted 200 hand-held echocardiography studies retrospectively as screen-positive, if mitral regurgitation ⩾1.5 cm and/or any aortic insufficiency were observed, or screen-negative from a pooled study library. The performance of experts receiving focussed hand-held protocols, non-experts receiving focussed hand-held protocols, and experts receiving complete hand-held protocols were determined in comparison with consensus interpretations on fully functional echocardiography machines. RESULTS: In all, 587 studies including 76 on definite rheumatic heart disease, 122 on borderline rheumatic heart disease, and 389 on normal cases were available for analysis. The focussed single-view protocol had a sensitivity of 81.1%, specificity of 75.5%, negative predictive value of 88.5%, and a positive predictive value of 63.2%; expert readers had higher specificity (86.1 versus 64.8%, p<0.01) but equal sensitivity. Sensitivity - experts, 96% and non-experts, 95% - and negative predictive value - experts, 99% and non-experts, 98% - were better for definite rheumatic heart disease. False-positive screening studies resulting from erroneous identification of mitral regurgitation and aortic insufficiency colour jets increased with shortened protocols and less experience (p<0.01). CONCLUSION: Our data support a focussed screening protocol limited to parasternal long-axis images. This holds promise in making echocardiographic screening more practical in regions where rheumatic heart disease remains endemic.
BACKGROUND: Echocardiographic screening represents an opportunity for reduction in the global burden of rheumatic heart disease. A focussed single-view screening protocol could allow for the rapid training of healthcare providers and screening of patients. OBJECTIVE: The aim of this study was to determine the sensitivity and specificity of a focussed single-view hand-held echocardiographic protocol for the diagnosis of rheumatic heart disease in children. METHODS: A total of nine readers were divided into three reading groups; each interpreted 200 hand-held echocardiography studies retrospectively as screen-positive, if mitral regurgitation ⩾1.5 cm and/or any aortic insufficiency were observed, or screen-negative from a pooled study library. The performance of experts receiving focussed hand-held protocols, non-experts receiving focussed hand-held protocols, and experts receiving complete hand-held protocols were determined in comparison with consensus interpretations on fully functional echocardiography machines. RESULTS: In all, 587 studies including 76 on definite rheumatic heart disease, 122 on borderline rheumatic heart disease, and 389 on normal cases were available for analysis. The focussed single-view protocol had a sensitivity of 81.1%, specificity of 75.5%, negative predictive value of 88.5%, and a positive predictive value of 63.2%; expert readers had higher specificity (86.1 versus 64.8%, p<0.01) but equal sensitivity. Sensitivity - experts, 96% and non-experts, 95% - and negative predictive value - experts, 99% and non-experts, 98% - were better for definite rheumatic heart disease. False-positive screening studies resulting from erroneous identification of mitral regurgitation and aortic insufficiency colour jets increased with shortened protocols and less experience (p<0.01). CONCLUSION: Our data support a focussed screening protocol limited to parasternal long-axis images. This holds promise in making echocardiographic screening more practical in regions where rheumatic heart disease remains endemic.
Authors: Bruno R Nascimento; Craig Sable; Maria Carmo P Nunes; Adriana C Diamantino; Kaciane K B Oliveira; Cassio M Oliveira; Zilda Maria A Meira; Sandra Regina T Castilho; Júlia P A Santos; Letícia Maria M Rabelo; Karlla C A Lauriano; Gabriel A L Carmo; Allison Tompsett; Antonio Luiz P Ribeiro; Andrea Z Beaton Journal: J Am Heart Assoc Date: 2018-02-14 Impact factor: 5.501
Authors: Bruno R Nascimento; Maria Carmo P Nunes; Emily M Lima; Amy E Sanyahumbi; Nigel Wilson; Elizabeth Tilton; Marc G W Rémond; Graeme P Maguire; Antonio Luiz P Ribeiro; Peter N Kazembe; Craig Sable; Andrea Z Beaton Journal: J Am Heart Assoc Date: 2021-09-17 Impact factor: 5.501
Authors: Joshua Reginald Francis; Helen Fairhurst; Gillian Whalley; Alex Kaethner; Anna Ralph; Jennifer Yan; James Cush; Vicki Wade; Andre Monteiro; Bo Remenyi Journal: BMJ Open Date: 2020-05-27 Impact factor: 2.692
Authors: Lisa Helen Telford; Leila Hussein Abdullahi; Eleanor Atieno Ochodo; Liesl Joanna Zuhlke; Mark Emmanuel Engel Journal: BMJ Open Date: 2020-10-29 Impact factor: 2.692
Authors: Alyssa DeWyer; Amy Scheel; Jenipher Kamarembo; Rose Akech; Allan Asiimwe; Andrea Beaton; Bua Bobson; Lesley Canales; Kristen DeStigter; Dhruv S Kazi; Gene F Kwan; Chris T Longenecker; Peter Lwabi; Meghna Murali; Emma Ndagire; Judith Namuyonga; Rachel Sarnacki; Isaac Ssinabulya; Emmy Okello; Twalib Aliku; Craig Sable Journal: PLoS One Date: 2021-08-06 Impact factor: 3.240