title: Screening for rheumatic heart disease: evaluation of a focused cardiac ultrasound approach.
abstract: BACKGROUND
  Rheumatic heart disease (RHD) remains a major public health problem worldwide. Although early diagnosis by echocardiography may potentially play a key role in developing active surveillance, systematic evaluation of simple approaches in resource poor settings are needed.
  
  
  RESULTS
  We prospectively compared focused cardiac ultrasound (FCU) to a reference approach for RHD screening in a school children population. FCU included (1) the use of a pocket-sized echocardiography machine, (2) nonexpert staff (2 nurses with specific training), and (3) a simplified set of echocardiographic criteria. The reference approach used standardized echocardiographic examination, reviewed by an expert cardiologist, according to 2012 World Heart Federation criteria. Among the 6 different echocardiographic criteria, first tested in a preliminary phase, mitral regurgitation jet length≥2 cm or any aortic regurgitation was considered best suited to be FCU criteria. Of the 1217 subjects enrolled (mean, 9.6±1 years; 49.6% male), 49 (4%) were diagnosed with RHD by the reference approach. The sensitivity of FCU for the detection of RHD was 83.7% (95% confidence interval, 73.3-94.0) for nurse A and 77.6% (95% confidence interval, 65.9-89.2) for nurse B. FCU yielded a specificity of 90.9% (95% confidence interval, 89.3-92.6) and 92.0% (95% confidence interval, 90.4-93.5) according to users. Percentage of agreement among nurses was 91.4%.
  
  
  CONCLUSIONS
  FCU by nonexperts using pocket devices seems feasible and yields acceptable sensitivity and specificity for RHD detection when compared with the state-of-the-art approach, thereby opening new perspectives for mass screening for RHD in low-resource settings.
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.). mariana.mirabel@inserm.fr.
authors.forename: Mariana
authors.initials: M
authors.lastname: Mirabel
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Raoul
authors.initials: R
authors.lastname: Bacquelin
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Corinne
authors.initials: C
authors.lastname: Robillard
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Bertrand
authors.initials: B
authors.lastname: Huon
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Philippe
authors.initials: P
authors.lastname: Corsenac
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Isabelle
authors.initials: I
authors.lastname: de Frémicourt
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Meunier
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Baptiste
authors.initials: B
authors.lastname: Noël
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Albert Alain
authors.initials: AA
authors.lastname: Hagège
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Bernard
authors.initials: B
authors.lastname: Rouchon
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.affiliation: From the Paris Cardiovascular Research Center, INSERM U970, Paris, France (M.M., R.B., M.T., K.N., X.J., E.M.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology Department, European Georges Pompidou Hospital, Paris, France (M.M., A.A.H., X.J., E.M.); Cardiology and Development, Paris, France (M.M., X.J., E.M.); Agence Sanitaire et Sociale de Nouvelle Calédonie, Nouméa, New Caledonia (C.R., B.H., P.C., J.-M.M., B.R.); Département de l'Action Sanitaire de Sociale des Iles Loyaté, Wé, Lifou, New Caledonia (I.d.F.); Cedars-Sinai Medical Center, Heart Institute, Los Angeles, CA (K.N.); and Centre Hospitalier Territorial de Nouvelle Calédonie, Nouméa, New Caledonia (B.N.).
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
mesh_terms: D000367:Age Factors; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000451:nursing / Q000503:physiopathology; D002648:Child; D018618:Echocardiography, Doppler, Color / Q000295:instrumentation / Q000379:methods* / Q000451:nursing; D004867:Equipment Design; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000295:instrumentation / Q000379:methods* / Q000451:nursing; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000451:nursing / Q000503:physiopathology
keywords: acute rheumatic fever; developing countries; epidemiology; heart valve diseases; rheumatic heart disease; ultrasound