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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
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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