title: The utility of handheld echocardiography for early diagnosis of rheumatic heart disease.
abstract: BACKGROUND
  Rheumatic heart disease (RHD) remains endemic in most of the developing world. Echocardiography has proved highly sensitive for early detection of RHD, but it remains too costly for most low-income settings. Handheld ultrasound machines used to perform handheld echocardiography (HAND) are both less expensive and more portable, possibly making them ideal screening tools. HAND has never been tested for the early diagnosis of RHD. The aim of this study was to evaluate the performance of focused HAND compared with focused standard portable echocardiography for the diagnosis of subclinical RHD.
  
  
  METHODS
  HAND and standard portable echocardiography were performed on 125 Ugandan children, 41 with borderline or definite RHD, and 84 healthy controls. Images were blindly reviewed according to the 2012 World Heart Federation guidelines.
  
  
  RESULTS
  HAND was highly sensitive (90.2%) and specific (92.9%) for distinguishing between normal patients and those with RHD, but it performed best with definite RHD. HAND overestimated mitral valve morphologic valve abnormalities, being only 66.7% specific for anterior leaflet thickness > 3 mm and 79.0% specific for restricted leaflet motion. False-negative results (n = 4) were due primarily to underestimation of mitral regurgitation length.
  
  
  CONCLUSIONS
  In this population, HAND was highly sensitive and specific for early detection of RHD. HAND functions best as a screening tool with confirmation of positive screening results by fully functional echocardiography machines. Technical advances may enable one-step RHD screening using HAND. The performance of HAND should be studied across diverse populations and in field tests before recommending it for widespread screening.
authors.affiliation: Division of Cardiology, Children's National Medical Center, Washington, District of Columbia. Electronic address: abeaton@cnmc.org.
authors.forename: Andrea
authors.initials: A
authors.lastname: Beaton
authors.affiliation: Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda.
authors.forename: Twalib
authors.initials: T
authors.lastname: Aliku
authors.affiliation: Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda.
authors.forename: Emmy
authors.initials: E
authors.lastname: Okello
authors.affiliation: Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda.
authors.forename: Sulaiman
authors.initials: S
authors.lastname: Lubega
authors.affiliation: Division of Cardiology, Children's National Medical Center, Washington, District of Columbia.
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.affiliation: Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda.
authors.forename: Peter
authors.initials: P
authors.lastname: Lwabi
authors.affiliation: Division of Cardiology, Children's National Medical Center, Washington, District of Columbia.
authors.forename: Craig
authors.initials: C
authors.lastname: Sable
mesh_terms: D002648:Child; D042241:Early Diagnosis; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008904:Miniaturization; D015588:Observer Variation; D015203:Reproducibility of Results; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity
keywords: Echocardiography; FCU; Focused cardiac ultrasound; HAND; Handheld echocardiography; RHD; Rheumatic heart disease; STAND; Screening; Standard portable echocardiography; WHF; World Heart Federation