Clinical InvestigationValvular Heart DiseaseSimplified Rheumatic Heart Disease Screening Criteria for Handheld Echocardiography
Section snippets
Study Population
This prospective study included five primary schools in Gulu, Uganda. All students 5 to 17 years of age were eligible for inclusion. Parents of minors provided written informed consent; adolescents >15 years of age provided informed consent, as is customary in Uganda. This study was approved by the institutional review boards at the University of Michigan, Children's National Medical Center, and Makerere University.
All enrolled children underwent STAND. A random subset of 10% of all subjects
Results
Of 4,773 subjects screened with STAND, 140 (2.9%) had borderline RHD by 2012 WHF criteria, and 52 (1.1%) had definite RHD, for a total prevalence of 4.0%. HAND was performed in 1,439 children (mean age, 10.8 ± 2.6 years; 47% male). Within this cohort, 133 (9.2%) had borderline RHD, 47 (3.3%) had definite RHD, and six (0.4%) had other diagnoses. The subset of children randomly assigned to HAND had a similar prevalence of disease to the overall cohort, with borderline RHD in 11 of 447 (2.5%) and
Discussion
We have shown that HAND, using screening criteria of MR jet length ≥ 1.5 cm or any AI, can detect any (borderline or definite) RHD with good sensitivity and specificity, with excellent sensitivity for definite RHD. To our knowledge, this is the first study to evaluate screening criteria for RHD using HAND in a large endemic population.
HAND is an attractive approach to screening for RHD because of the highest prevalence of RHD in resource-limited populations. HAND machines are less expensive,
Conclusions
HAND offers promise in extending the reach of screening for RHD in resource-limited populations. Simplified criteria of MR jet length ≥ 1.5 cm or any AI can detect RHD with good sensitivity and specificity and greatly reduce the need for standard echocardiography. Further studies are needed to evaluate differences in outcomes with early detection, as well as the accuracy of handheld echocardiographic screening in the hands of nonphysicians, particularly local caregivers such as nurses.
Acknowledgments
The authors thank Alison Reese, Ashley Shrestha-Astudillo, Peter Dean, Lasya Gaur, and Jacqueline Weinberg for assistance in performing echocardiograms; the Rotary Club of Gulu for organizational and logistical support throughout this project; as well as the children and families who consented for participation.
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This project was supported by Award Nos. UL1TR000075 and KL2TR000076 from the NIH National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Advancing Translational Sciences or the National Institutes of Health. This study was also funded in part by grants from General Electric, the World Heart Federation, and the CHAMPS for Mott fund.