title: The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study.
abstract: OBJECTIVE
  The World Heart Federation (WHF) guidelines for rheumatic heart disease (RHD) are designed for a standard portable echocardiography (STAND) machine. A recent study in a tertiary care centre demonstrated that they also had good sensitivity and specificity when modified for use with handheld echocardiography (HAND). Our study aimed to evaluate the performance of HAND for early RHD diagnosis in the setting of a large-scale field screening.
  
  
  RESULTS
  STAND was performed in 4773 children in Gulu, Uganda, with 10% randomly assigned to also undergo HAND. Additionally, any child with mitral or aortic regurgitation also underwent HAND. Studies were performed by experienced echocardiographers and blindly reviewed by cardiologists using 2012 WHF criteria, which were modified slightly for HAND--due to the lack of spectral Doppler capability. Paired echocardiograms were performed in 1420 children (mean age 10.8 and 53% female), resulting in 1234 children who were normal, 133 who met criteria for borderline RHD, 47 who met criteria for definite RHD, and 6 who had other diagnoses. HAND had good sensitivity and specificity for RHD detection (78.9 and 87.2%, respectively), but was most sensitive for definite RHD (97.9%). Inter- and intra-reviewer agreement ranged between 66-83 and 71.4-94.1%, respectively.
  
  
  CONCLUSIONS
  HAND has good sensitivity and specificity for diagnosis of early RHD, performing best for definite RHD. Protocols for RHD detection utilizing HAND will need to include confirmation by STAND to avoid over-diagnosis. Strategies that evaluate simplified screening protocols and training of non-physicians hold promise for more wide spread deployment of HAND-based protocols.
authors.affiliation: Children's National Medical Center, Washington, DC, USA abeaton@childrensnational.org.
authors.forename: Andrea
authors.initials: A
authors.lastname: Beaton
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Jimmy C
authors.initials: JC
authors.lastname: Lu
authors.affiliation: Gulu Regional Referral Hospital, Gulu, Uganda.
authors.forename: Twalib
authors.initials: T
authors.lastname: Aliku
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Dean
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: Lasya
authors.initials: L
authors.lastname: Gaur
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Weinberg
authors.affiliation: Vanderbilt University, Nashville, TN, USA.
authors.forename: Justin
authors.initials: J
authors.lastname: Godown
authors.affiliation: Uganda Heart Institute, Kampala, Uganda.
authors.forename: Peter
authors.initials: P
authors.lastname: Lwabi
authors.affiliation: Joint Clinical Research Center, Kampala, Uganda.
authors.forename: Grace
authors.initials: G
authors.lastname: Mirembe
authors.affiliation: Uganda Heart Institute, Kampala, Uganda.
authors.forename: Emmy
authors.initials: E
authors.lastname: Okello
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: Allison
authors.initials: A
authors.lastname: Reese
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Ashley
authors.initials: A
authors.lastname: Shrestha-Astudillo
authors.affiliation: George Washington University, Washington, DC, USA.
authors.forename: Tyler
authors.initials: T
authors.lastname: Bradley-Hewitt
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: Janet
authors.initials: J
authors.lastname: Scheel
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Webb
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: McCarter
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Greg
authors.initials: G
authors.lastname: Ensing
authors.affiliation: Children's National Medical Center, Washington, DC, USA.
authors.forename: Craig
authors.initials: C
authors.lastname: Sable
mesh_terms: D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology; D002648:Child; D042241:Early Diagnosis; D004452:Echocardiography / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D012680:Sensitivity and Specificity; D014454:Uganda / Q000453:epidemiology
keywords: Epidemiology; Handheld echocardiography; Rheumatic heart disease; Screening