title: Echocardiographic screening for rheumatic heart disease: age matters.
abstract: BACKGROUND
  Echocardiography is emerging as a screening tool for rheumatic heart disease (RHD) in endemic regions. The vast majority of surveys have been limited to children. We ought to appreciate the interest of including adolescents in their late teens in such school screening programmes.
  
  
  METHODS
  School-based echocardiography cross-sectional survey conducted in Dakar, Senegal (March 2010). A total of 2004 school attendees were randomly selected and enrolled in the study, among which 1116 were aged 5-15 years old (group 1), and 888 were 16-18 years old (group 2). Case detection rates and phenotype of RHD were compared according to age groups.
  
  
  RESULTS
  A total of 22 youngsters were suspected by on-site echocardiography, 12 in group 1 and 10 in group 2. Among the 12 RHD cases suspected on-site in group 1, 6 (50%) were eventually considered as confirmed RHD, compared to 9 out of 10 (90%) in group 2, giving prevalence rates of 5.4 (CI 95% 2.0-11.7) and 10.1 (CI 95% 4.6-19.2) per 1000 in group 1 and group 2, respectively. The proportion of marked/advanced lesions was 33% in group 1, and 89% in group 2 (p=0.08). Mean concordance rates between the 3 reviewers were 40% for group 1, compared to 93% in group 2 (p=0.05).
  
  
  CONCLUSIONS
  Extension of screening to adolescents in their late teens should be considered with interest in the light of the higher prevalence of the disease and relative clarity of subclinical cardiac lesions that could be more easily detected in the field.
authors.affiliation: Hôpital Général Grand Yoff, Dakar, Senegal.
authors.forename: Abdoul
authors.initials: A
authors.lastname: Kane
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
authors.forename: Kamadore
authors.initials: K
authors.lastname: Touré
authors.forename: Marie-Cécile
authors.initials: MC
authors.lastname: Périer
authors.forename: Samia
authors.initials: S
authors.lastname: Fazaa
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.forename: Nicole
authors.initials: N
authors.lastname: Karam
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Zourak
authors.forename: Dior
authors.initials: D
authors.lastname: Diagne
authors.forename: Alassane
authors.initials: A
authors.lastname: Mbaye
authors.forename: Moussa
authors.initials: M
authors.lastname: Kane
authors.forename: Bouna
authors.initials: B
authors.lastname: Diack
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
mesh_terms: D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler / Q000379:methods / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000592:standards*; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012572:School Health Services / Q000592:standards*; D012675:Senegal / Q000453:epidemiology