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Optimising echocardiographic screening for rheumatic heart disease in New Zealand: not all valve disease is rheumatic

Published online by Cambridge University Press:  31 March 2011

Rachel H. Webb ,
Nigel J. Wilson ,
Diana R. Lennon ,
Elizabeth M. Wilson ,
Ross W. Nicholson ,
Tom L. Gentles ,
Clare P. O'Donnell ,
John W. Stirling ,
Irene Zeng  and
Adrian A. Trenholme
Rachel H. Webb
Affiliation:
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
Nigel J. Wilson*
Affiliation:
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand
Diana R. Lennon
Affiliation:
Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand KidzFirst Children's Health, Counties Manukau District Health Board, Auckland, New Zealand Department of Paediatrics, School of Population Health, University of Auckland, Auckland, New Zealand
Elizabeth M. Wilson
Affiliation:
Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand
Ross W. Nicholson
Affiliation:
KidzFirst Children's Health, Counties Manukau District Health Board, Auckland, New Zealand
Tom L. Gentles
Affiliation:
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand
Clare P. O'Donnell
Affiliation:
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand
John W. Stirling
Affiliation:
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand
Irene Zeng
Affiliation:
Department of Cardiac Physiology, Green Lane Cardiac Services, Auckland City Hospital, Auckland, New Zealand
Adrian A. Trenholme
Affiliation:
KidzFirst Children's Health, Counties Manukau District Health Board, Auckland, New Zealand
*
Correspondence to: Dr N. J. Wilson, Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland District Health Board, Private Bag 92-024, Auckland, New Zealand. Tel: +64 9 367 0000; Fax: +64 9 6310785; E-mail: nigelw@adhb.govt.nz
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Abstract

Aims

Echocardiography detects a greater prevalence of rheumatic heart disease than heart auscultation. Echocardiographic screening for rheumatic heart disease combined with secondary prophylaxis may potentially prevent severe rheumatic heart disease in high-risk populations. We aimed to determine the prevalence of rheumatic heart disease in children from an urban New Zealand population at high risk for acute rheumatic fever.

Methods and results

To optimise accurate diagnosis of rheumatic heart disease, we utilised a two-step model. Portable echocardiography was conducted on 1142 predominantly Māori and Pacific children aged 10–13 years. Children with an abnormal screening echocardiogram underwent clinical assessment by a paediatric cardiologist together with hospital-based echocardiography. Rheumatic heart disease was then classified as definite, probable, or possible. Portable echocardiography identified changes suggestive of rheumatic heart disease in 95 (8.3%) of 1142 children, which reduced to 59 (5.2%) after cardiology assessment. The prevalence of definite and probable rheumatic heart disease was 26.0 of 1000, with 95% confidence intervals ranging from 12.6 to 39.4. Portable echocardiography overdiagnosed rheumatic heart disease with physiological valve regurgitation diagnosed in 28 children. A total of 30 children (2.6%) had non-rheumatic cardiac abnormalities, 11 of whom had minor congenital mitral valve anomalies.

Conclusions

We found high rates of undetected rheumatic heart disease in this high-risk population. Rheumatic heart disease screening has resource implications with cardiology evaluation required for accurate diagnosis. Echocardiographic screening for rheumatic heart disease may overdiagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

Keywords

Rheumatic heart diseaseechocardiographypublic health screening
Type
Original Articles
Information
Cardiology in the Young , Volume 21 , Issue 4 , 12 July 2011 , pp. 436 - 443
Copyright
Copyright © Cambridge University Press 2011

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