title: World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline.
abstract: Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: 'definite RHD', 'borderline RHD', and 'normal'. Four subcategories of 'definite RHD' and three subcategories of 'borderline RHD' exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control.
authors.affiliation: Green Lane Pediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand. Bo.Remenyi@menzies.edu.au
authors.forename: Bo
authors.initials: B
authors.lastname: Reményi
authors.forename: Nigel
authors.initials: N
authors.lastname: Wilson
authors.forename: Andrew
authors.initials: A
authors.lastname: Steer
authors.forename: Beatriz
authors.initials: B
authors.lastname: Ferreira
authors.forename: Joseph
authors.initials: J
authors.lastname: Kado
authors.forename: Krishna
authors.initials: K
authors.lastname: Kumar
authors.forename: John
authors.initials: J
authors.lastname: Lawrenson
authors.forename: Graeme
authors.initials: G
authors.lastname: Maguire
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
authors.forename: Ana Olga
authors.initials: AO
authors.lastname: Mocumbi
authors.forename: Cleonice
authors.initials: C
authors.lastname: Mota
authors.forename: John
authors.initials: J
authors.lastname: Paar
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.forename: Janet
authors.initials: J
authors.lastname: Scheel
authors.forename: John
authors.initials: J
authors.lastname: Stirling
authors.forename: Satupaitea
authors.initials: S
authors.lastname: Viali
authors.forename: Vijayalakshmi I
authors.initials: VI
authors.lastname: Balekundri
authors.forename: Gavin
authors.initials: G
authors.lastname: Wheaton
authors.forename: Liesl
authors.initials: L
authors.lastname: Zühlke
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carapetis
mesh_terms: D004452:Echocardiography / Q000592:standards*; D019317:Evidence-Based Medicine; D006801:Humans; D008403:Mass Screening / Q000379:methods; D017410:Practice Guidelines as Topic / Q000592:standards*; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging*; D012955:Societies, Medical