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A rapid echocardiographic screening protocol for rheumatic heart disease in Samoa: a high prevalence of advanced disease

Published online by Cambridge University Press:  15 June 2017

Marvin Allen ,
John Allen ,
Take Naseri ,
Rebecca Gardner ,
Dennis Tolley  and
Lori Allen
Marvin Allen*
Affiliation:
Brigham Young University, Provo, Utah, United States of America
John Allen
Affiliation:
Brigham Young University, Provo, Utah, United States of America
Take Naseri
Affiliation:
Samoan Ministries of Health, Apia, Samoa
Rebecca Gardner
Affiliation:
Department of Statistics, Brigham Young University, Provo, Utah, United States of America
Dennis Tolley
Affiliation:
Department of Statistics, Brigham Young University, Provo, Utah, United States of America
Lori Allen
Affiliation:
Department of Biology, Brigham Young University, Provo, Utah, United States of America
*
Correspondence to: M. Allen, Brigham Young University, Provo, Utah 84664, United States of America. E-mail: [email protected]
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Abstract

Background

Echocardiography has been proposed as a method to screen children for rheumatic heart disease. The World Heart Federation has established guidelines for echocardiographic screening. In this study, we describe a rapid echocardiogram screening protocol according to the World Heart Federation guidelines in Samoa, endemic for rheumatic heart disease.

Methods

We performed echocardiogram screening in schoolchildren in Samoa between 2013 and 2015. A brief screening echocardiogram was performed on all students. Children with predefined criteria suspicious for rheumatic hear diseases were referred for a more comprehensive echocardiogram. Complete echocardiograms were classified according to the World Heart Federation guidelines and severity of valve disease.

Results

Echocardiographic screening was performed on 11,434 children, with a mean age of 10.2 years; 51% of them were females. A total of 558 (4.8%) children underwent comprehensive echocardiography, including 49 students who were randomly selected as controls. Definite rheumatic heart disease was observed in 115 students (10.0 per 1000): 92 students were classified as borderline (8.0 per 1000) and 23 with CHD. Advanced disease was identified in 50 students (4.4 per 1000): 15 with severe mitral regurgitation, five with severe aortic regurgitation, 11 with mitral stenoses, and 19 with mitral and aortic valve disease.

Conclusions

We successfully applied a rapid echocardiographic screening protocol to a large number of students over a short time period – 28 days of screening over a 3-year time period – to identify a high prevalence of rheumatic heart disease. We also reported a significantly higher rate of advanced disease compared with previously published echocardiographic screening programmes.

Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 8 , October 2017 , pp. 1599 - 1605
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Copyright
© Cambridge University Press 2017 

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