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Evaluation of a focussed protocol for hand-held echocardiography and computer-assisted auscultation in detecting latent rheumatic heart disease in scholars

Published online by Cambridge University Press:  01 October 2015

Liesl J. Zühlke ,
Mark E. Engel ,
Simpiwe Nkepu  and
Bongani M. Mayosi
Liesl J. Zühlke*
Affiliation:
Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa Department of Paediatrics and Child Health, Division of Paediatric Cardiology, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
Mark E. Engel
Affiliation:
Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
Simpiwe Nkepu
Affiliation:
Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
Bongani M. Mayosi
Affiliation:
Department of Medicine, The Cardiac Clinic, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
*
Correspondence to: Dr L. Zühlke, Department of Medicine, J46.43 Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, South Africa. Tel: +2 721 404 7676; Fax: +2 721 448 6815; E-mail: [email protected]
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Abstract

Introduction

Echocardiography is the diagnostic test of choice for latent rheumatic heart disease. The utility of echocardiography for large-scale screening is limited by high cost, complex diagnostic protocols, and time to acquire multiple images. We evaluated the performance of a brief hand-held echocardiography protocol and computer-assisted auscultation in detecting latent rheumatic heart disease with or without pathological murmur.

Methods

A total of 27 asymptomatic patients with latent rheumatic heart disease based on the World Heart Federation criteria and 66 healthy controls were examined by standard cardiac auscultation to detect pathological murmur. Hand-held echocardiography using a focussed protocol that utilises one view – that is, the parasternal long-axis view – and one measurement – that is, mitral regurgitant jet – and a computer-assisted auscultation utilising an automated decision tool were performed on all patients.

Results

The sensitivity and specificity of computer-assisted auscultation in latent rheumatic heart disease were 4% (95% CI 1.0–20.4%) and 93.7% (95% CI 84.5–98.3%), respectively. The sensitivity and specificity of the focussed hand-held echocardiography protocol for definite rheumatic heart disease were 92.3% (95% CI 63.9–99.8%) and 100%, respectively. The test reliability of hand-held echocardiography was 98.7% for definite and 94.7% for borderline disease, and the adjusted diagnostic odds ratios were 1041 and 263.9 for definite and borderline disease, respectively.

Conclusion

Computer-assisted auscultation has extremely low sensitivity but high specificity for pathological murmur in latent rheumatic heart disease. Focussed hand-held echocardiography has fair sensitivity but high specificity and diagnostic utility for definite or borderline rheumatic heart disease in asymptomatic patients.

Keywords

Latent rheumatic heart diseasecomputer-assisted auscultationportable ultrasoundWorld Heart Federation criteria
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 6 , August 2016 , pp. 1097 - 1106
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Copyright
© Cambridge University Press 2015 

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References

1. Rothenbuhler, M, O’Sullivan, CJ, Stortecky, S, et al. Active surveillance for rheumatic heart disease in endemic regions: a systematic review and meta-analysis of prevalence among children and adolescents. Lancet Global Health 2014; 2: e717–e726.Google Scholar
2. Saxena, A, Ramakrishnan, S, Roy, A, et al. Prevalence and outcome of subclinical rheumatic heart disease in India: the RHEUMATIC (Rheumatic Heart Echo Utilisation and Monitoring Actuarial Trends in Indian Children) study. Heart 2011; 97: 2018–2022.Google Scholar
3. 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.Google Scholar
4. Carapetis, JR, Hardy, M, Fakakovikaetau, T, et al. Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren. Nat Clin Pract Cardiovasc Med 2008; 5: 411–417.Google Scholar
5. 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.Google Scholar
6. Marijon, E, Tivane, A, Voicu, S, et al. Prevalence of congenital heart disease in schoolchildren of sub-Saharan Africa, Mozambique. Int J Cardiol 2006; 113: 440–441.Google Scholar
7. 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.Google Scholar
8. Ba-Saddik, IA, Munibari, AA, Al-Naqeeb, MS, et al. Prevalence of rheumatic heart disease among school-children in Aden, Yemen. Ann Trop Paediatr 2011; 31: 37–46.Google Scholar
9. Paar, JA, Berrios, NM, Rose, JD, et al. Prevalence of rheumatic heart disease in children and young adults in Nicaragua. Am J Cardiol 2010; 105: 1809–1814.Google Scholar
10. Bhaya, M, Panwar, S, Beniwal, R, Panwar, RB. High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography 2010; 27: 448–453.Google Scholar
11. Anabwani, GM, Bonhoeffer, P. Prevalence of heart disease in school children in rural Kenya using colour-flow echocardiography. East Afr Med J 1996; 73: 215–217.Google Scholar
12. Marijon, E, Tafflet, M, Jouven, X. Time to use ultrasound and not stethoscopes for rheumatic heart disease screening. Nat Clin Pract Cardiovasc Med 2008; 5: E1–E3.Google Scholar
13. Grimaldi, A, Ammirati, E, Mirabel, M, Marijon, E. Challenges of using ultrasounds for subclinical rheumatic heart disease screening. Int J Cardiol 2013; 167: 3061.Google Scholar
14. Gewitz, MH, Baltimore, RS, Tani, LY, et al. Revision of the Jones criteria for the diagnosis of acute rheumatic fever in the era of Doppler echocardiography: a scientific statement from the American Heart Association. Circulation 2015; 131: 1806–1818.Google Scholar
15. Remenyi, B, Wilson, N, Steer, A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease – an evidence-based guideline. Nat Rev Cardiol 2012; 9: 297–309.Google Scholar
16. Mirabel, M, Celermajer, DS, Ferreira, B, et al. Screening for rheumatic heart disease: evaluation of a simplified echocardiography-based approach. Eur Heart J Cardiovasc Imaging 2012; 13: 1024–1029.Google Scholar
17. Zühlke, L, Mayosi, BM. Echocardiographic screening for subclinical rheumatic heart disease remains a research tool pending studies of impact on prognosis. Curr Cardiol Rep 2013; 15: 343.Google Scholar
18. Zühlke, L, Myer, L, Mayosi, BM. The promise of computer-assisted auscultation in screening for structural heart disease and clinical teaching. Cardiovasc J Afr 2012; 23: 405–408.Google Scholar
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.Google Scholar
20. Mirabel, M, Celermajer, DS, Ferreira, B, et al. Screening for rheumatic heart disease: evaluation of a simplified echocardiography-based approach. Eur Heart J Cardiovasc Imaging 2012; 13: 1024–1029.Google Scholar
21. Engel, ME, Haileamlak, A, Zühlke, L, et al. Latent rheumatic heart disease in 4720 asymptomatic schoolchildren from South Africa and Ethiopia. Heart 2015; 101: 1389–1394.Google Scholar
22. Engel, M, Zühlke, L, Robertson, KA. ASAP programme: rheumatic fever and rheumatic heart disease: where are we now in South Africa? SA Heart 2009; 6: 270–273.Google Scholar
23. Remenyi, B, Wilson, N, Steer, A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease – an evidence-based guideline. Nat Rev Cardiol 2012; 9: 297–309.Google Scholar
24. Akobeng, AK. Understanding diagnostic tests 2: likelihood ratios, pre- and post-test probabilities and their use in clinical practice. Acta Paediatr 2007; 96: 487–491.Google Scholar
25. Glas, AS, Lijmer, JG, Prins, MH, Bonsel, GJ, Bossuyt, PMM. The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 2003; 56: 1129–1135.CrossRefGoogle ScholarPubMed
26. Zhou, X-H, Obuchowski, NA, McClish, DK. Statistical Methods in Diagnostic Medicine (Wiley Series in Probability and Statistics). Wiley, West Sussex, UK, 2011.Google Scholar
27. Bossuyt, PM, Reitsma, JB, Bruns, DE, et al. The STARD statement for reporting studies of diagnostic accuracy: explanation and elaboration. The standards for reporting of diagnostic accuracy group. Croat Med J 2003; 44: 639–650.Google Scholar
28. Vandenbroucke, JP, von Elm, E, Altman, DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014; 12: 1500–1524.Google Scholar
29. Reeves, BM, Kado, J, Brook, M. High prevalence of rheumatic heart disease in Fiji detected by echocardiography screening. J Paediatr Child Health 2011; 47: 473–478.Google Scholar
30. 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.Google Scholar
31. 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: 1–8.Google Scholar
32. 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.Google Scholar
33. Mirabel, M, Fauchier, T, Bacquelin, R, et al. Echocardiography screening to detect rheumatic heart disease: a cohort study of schoolchildren in French Pacific Islands. Int J Cardiol 2015; 188: 89–95.Google Scholar
34. Godown, J, Lu, JC, Beaton, A, et al. Handheld echocardiography versus auscultation for detection of rheumatic heart disease. Pediatrics 2015; 135: e939–e944.Google Scholar
35. Otto, H, Saether, SG, Banteyrga, L, Haugen, BO, Skjaerpe, T. High prevalence of subclinical rheumatic heart disease in pregnant women in a developing country: an echocardiographic study. Echocardiography 2011; 28: 1049–1053.Google Scholar
36. Kothari, SS. Letter by Kothari regarding article, “Rheumatic heart disease screening by echocardiography: the inadequacy of World Health Organization criteria for optimizing the diagnosis of subclinical disease”. Circulation 2010; 121: e420, author reply e423.Google Scholar
37. DeGroff, CG. Letter by DeGroff regarding article, “Rheumatic heart disease screening by echocardiography: the inadequacy of World Health Organization criteria for optimizing the diagnosis of subclinical disease”. Circulation 2010; 121: e421, author reply e423.Google Scholar
38. Roberts, K, Maguire, G, Brown, A, et al. Prevalence of rheumatic heart disease in high-risk children in Northern Australia: application of the 2012 World Heart Federation criteria: abstract no 815. SA Heart 2013; 10: 270.Google Scholar
39. Colquhoun, SM, Carapetis, JR, Kado, JH, et al. Pilot study of nurse-led rheumatic heart disease echocardiography screening in Fiji – a novel approach in a resource-poor setting. Cardiol Young 2013; 23: 546–552.Google Scholar
40. Saxena, A, Zühlke, L, Wilson, N. Echocardiographic screening for rheumatic heart disease: issues for the cardiology community. Global Heart 2013; 8: 197–202.Google Scholar
41. Kane, A, Mirabel, M, Toure, K, et al. Echocardiographic screening for rheumatic heart disease: age matters. Int J Cardiol 2013; 168: 888–891.Google Scholar
42. Steer, AC, Kado, J, Wilson, N, et al. High prevalence of rheumatic heart disease by clinical and echocardiographic screening among children in Fiji. J Heart Valve Dis 2009; 18: 327–335; discussion 336.Google Scholar
43. Tavel, ME. Cardiac auscultation: a new method for instruction. Med Educ 2010; 44: 1132.Google Scholar
44. Tavel, ME. Cardiac auscultation: a glorious past – and it does have a future!. Circulation 2006; 113: 1255–1259.Google Scholar
45. Zühlke, L, Myer, L, Mayosi, BM. The promise of computer-assisted auscultation in screening for structural heart disease and clinical teaching. Cardiovasc J Africa 2012; 23: 1–4.Google Scholar
46. WHO. Rheumatic Fever and Rheumatic Heart Disease. Report of a WHO Expert Consultation. WHO, Geneva, 2004.Google Scholar
47. Mayosi, BM. Letter regarding article, “Echocardiography screening for rheumatic heart disease in Ugandan schoolchildren”. Circulation 2012; 126: e476, author reply e478–e479.Google Scholar
48. Zachariah, JP, Samnaliev, M. Echo-based screening of rheumatic heart disease in children: a cost-effectiveness Markov model. J Med Econ 2015; 18: 410–419.Google Scholar
49. Mayosi, BM, Gamra, H, Dangou, JM, Kasonde, J. Rheumatic heart disease in Africa: the Mosi-o-Tunya call to action. Lancet Global Health 2014; 2: e438–e439.Google Scholar
50. Minich, LL, Tani, LY, Pagotto, LT, Shaddy, RE, Veasy, LG. Doppler echocardiography distinguishes between physiologic and pathologic “silent” mitral regurgitation in patients with rheumatic fever. Clin Cardiol 1997; 20: 924–926.Google Scholar