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A focussed single-view hand-held echocardiography protocol for the detection of rheumatic heart disease

Published online by Cambridge University Press:  11 September 2017

Adriana Diamantino ,
Andrea Beaton ,
Twalib Aliku ,
Kaciane Oliveira ,
Cassio Oliveira ,
Luciana Xavier ,
Lindsay Perlman ,
Emmy Okello ,
Bruno Nascimento  and
Antonio R. P. Ribeiro
...Show all authors
Adriana Diamantino
Affiliation:
Hospital Das Clinicas, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Andrea Beaton
Affiliation:
Children’s National Health System, Washington, District of Columbia, United States of America
Twalib Aliku
Affiliation:
Gulu University, Gulu, Uganda
Kaciane Oliveira
Affiliation:
Hospital Das Clinicas, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Cassio Oliveira
Affiliation:
Hospital Das Clinicas, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Luciana Xavier
Affiliation:
Hospital Das Clinicas, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Lindsay Perlman
Affiliation:
Hospital Das Clinicas, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Emmy Okello
Affiliation:
Uganda Heart Institute, Kampala, Uganda
Bruno Nascimento
Affiliation:
Hospital Das Clinicas, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Antonio R. P. Ribeiro
Affiliation:
Children’s National Health System, Washington, District of Columbia, United States of America
Maria C. P. Nunes
Affiliation:
Hospital Das Clinicas, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
Craig Sable*
Affiliation:
Children’s National Health System, Washington, District of Columbia, United States of America
*
Correspondence to: C. Sable, MD, Children’s National Health System, 111 Michigan Avenue, NW, Washington, DC 20010, United States of America. Tel: +1 202 476 2020; Fax: 1 202 476 5700; E-mail: csable@childrensnational.org
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Abstract

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.

Keywords

Rheumatic heart diseasehand-held echocardiographytask shifting

Information

Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 1 , January 2018 , pp. 108 - 117
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Copyright
© Cambridge University Press 2017 

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References

1. Carapetis, JR, Steer, AC, Mulholland, EK, Weber, M. The global burden of group A streptococcal diseases. Lancet Infect Dis 2005; 5: 685–694.CrossRefGoogle Scholar
2. Global Burden of Disease Study C. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 386: 743–800.CrossRefGoogle Scholar
3. Zuhlke, L, Engel, ME, Karthikeyan, G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J 2015; 36: 1115–1122a.CrossRefGoogle ScholarPubMed
4. Zuhlke, L, Karthikeyan, G, Engel, ME, et al. Clinical outcomes in 3343 children and adults with rheumatic heart disease from 14 low- and middle-income countries: two-year follow-up of the Global Rheumatic Heart Disease Registry (the REMEDY Study). Circulation 2016; 134: 1456–1466.CrossRefGoogle ScholarPubMed
5. Beaton, A, Okello, E, Lwabi, P, Mondo, C, McCarter, R, Sable, C. Echocardiography screening for rheumatic heart disease in Ugandan schoolchildren. Circulation 2012; 125: 3127–3132.CrossRefGoogle ScholarPubMed
6. Marijon, E, Ou, P, Celermajer, DS, et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. N Engl J Med 2007; 357: 470–476.CrossRefGoogle ScholarPubMed
7. Roberts, KV, Brown, AD, Maguire, GP, Atkinson, DN, Carapetis, JR. Utility of auscultatory screening for detecting rheumatic heart disease in high-risk children in Australia’s Northern Territory. Med J Aust 2013; 199: 196–199.CrossRefGoogle ScholarPubMed
8. Nascimento, BR, Beaton, AZ, Nunes, MC, et al. Echocardiographic prevalence of rheumatic heart disease in Brazilian schoolchildren: data from the PROVAR study. Int J Cardiol 2016; 219: 439–445.CrossRefGoogle ScholarPubMed
9. Mirabel, M, Bacquelin, R, Tafflet, M, et al. Screening for rheumatic heart disease: evaluation of a focused cardiac ultrasound approach. Circ Cardiovasc Imaging 2015; 8.CrossRefGoogle ScholarPubMed
10. Lu, JC, Sable, C, Ensing, GJ, et al. Simplified rheumatic heart disease screening criteria for handheld echocardiography. J Am Soc Echocardiogr 2015; 28: 463–469.CrossRefGoogle ScholarPubMed
11. Godown, J, Lu, JC, Beaton, A, et al. Handheld echocardiography versus auscultation for detection of rheumatic heart disease. Pediatrics 2015; 135: e939–e944.CrossRefGoogle ScholarPubMed
12. Ploutz, M, Lu, JC, Scheel, J, et al. Handheld echocardiographic screening for rheumatic heart disease by non-experts. Heart 2016; 102: 35–39.CrossRefGoogle ScholarPubMed
13. Beaton, A, Nascimento, BR, Diamantino, AC, et al. Efficacy of a standardized computer-based training curriculum to teach echocardiographic identification of rheumatic heart disease to nonexpert users. Am J Cardiol 2016; 117: 1783–1789.CrossRefGoogle ScholarPubMed
14. Mark, DG, Ku, BS, Carr, BG, et al. Directed bedside transthoracic echocardiography: preferred cardiac window for left ventricular ejection fraction estimation in critically ill patients. Am J Emerg Med 2007; 25: 894–900.CrossRefGoogle ScholarPubMed
15. Alzahrani, H, Woo, MY, Johnson, C, Pageau, P, Millington, S, Thiruganasambandamoorthy, V. Can severe aortic stenosis be identified by emergency physicians when interpreting a simplified two-view echocardiogram obtained by trained echocardiographers? Crit Ultrasound J 2015; 7: 5.CrossRefGoogle ScholarPubMed
16. Remenyi, B, Wilson, N, Steer, A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease – an evidence-based guideline. Nature Rev Cardiol 2012; 9: 297–309.CrossRefGoogle ScholarPubMed
17. Beaton, A, Okello, E, Aliku, T, et al. Latent rheumatic heart disease: outcomes 2 years after echocardiographic detection. Pediatr Cardiol 2014; 35: 1259–1267.CrossRefGoogle ScholarPubMed
18. Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42: 377–381.CrossRefGoogle ScholarPubMed
19. Beaton, A, Aliku, T, Okello, E, et al. The utility of handheld echocardiography for early diagnosis of rheumatic heart disease. J Am Soc Echocardiogr 2014; 27: 42–49.CrossRefGoogle ScholarPubMed
20. Beaton, A, Lu, JC, Aliku, T, et al. The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study. Eur Heart J Cardiovasc Imaging 2015; 16: 475–482.CrossRefGoogle ScholarPubMed
21. Godown, J, Beaton, A. Handheld echocardiography: a new tool for rheumatic heart disease screening in the developing world? Transl Pediatr 2015; 4: 252–253.Google Scholar
22. Nascimento, BR, Nunes, MC, Lopes, EL, et al. Rheumatic heart disease echocardiographic screening: approaching practical and affordable solutions. Heart 2016; 102: 658–664.CrossRefGoogle ScholarPubMed
23. Engelman, D, Okello, E, Beaton, A, et al. Evaluation of computer-based training for health workers in echocardiography for rheumatic heart disease. Global Heart, 2017; 12: 17–23.CrossRefGoogle Scholar
24. Carapetis, JR, Beaton, A, Cunningham, MW, et al. Acute rheumatic fever and rheumatic heart disease. Nat Rev Dis Primers 2016; 2: 15084.CrossRefGoogle ScholarPubMed
25. Engelman, D, Kado, JH, Remenyi, B, et al. Focused cardiac ultrasound screening for rheumatic heart disease by briefly trained health workers: a study of diagnostic accuracy. Lancet Global Health 2016; 4: e386–e394.CrossRefGoogle ScholarPubMed
26. D’hooge, J, Merten, L. Ultrasound physics. In: Lai WW, Cohen M, Geva T (eds). Echocardiography in Pediatric and Congenital Heart Disease: From Fetus to Adult, 2nd edn. Wiley, 2016: 3–14.Google Scholar
27. Simpson, JM, Miller, O. Anomalies of the left ventricular outflow tract and aortic valve. In: Lai WW, Cohen M, Geva T (eds). Echocardiography in Pediatric and Congenital Heart Disease: From Fetus to Adult, 2nd edn. Wiley, 2016: 297–314.Google Scholar
28. Sicari, R, Galderisi, M, Voigt, JU, et al. The use of pocket-size imaging devices: a position statement of the European Association of Echocardiography. Eur J Echocardiogr 2011; 12: 85–87.CrossRefGoogle ScholarPubMed
29. Spencer, KT, Kimura, BJ, Korcarz, CE, Pellikka, PA, Rahko, PS, Siegel, RJ. Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 2013; 26: 567–581.CrossRefGoogle ScholarPubMed
30. Engelman, D, Kado, JH, Remenyi, B, et al. Teaching focused echocardiography for rheumatic heart disease screening. Ann Pediatr Cardiol 2015; 8: 118–121.CrossRefGoogle ScholarPubMed
31. Zuhlke, LJ, Engel, ME, Nkepu, S, Mayosi, BM. Evaluation of a focussed protocol for hand-held echocardiography and computer-assisted auscultation in detecting latent rheumatic heart disease in scholars. Cardiol Young 2016; 26: 1097–1106.CrossRefGoogle ScholarPubMed
32. Zoghbi, WA, Adams, D, Bonow, RO, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 2017; 30: 303–371.CrossRefGoogle ScholarPubMed