title: Simplified rheumatic heart disease screening criteria for handheld echocardiography.
abstract: BACKGROUND
  Using 2012 World Heart Federation criteria, standard portable echocardiography (STAND) reveals a high burden of rheumatic heart disease (RHD) in resource-poor settings, but widespread screening is limited by cost and physician availability. Handheld echocardiography (HAND) may decrease costs, but World Heart Federation criteria are complicated for rapid field screening, particularly for nonphysician screeners. The aim of this study was to determine the best simplified screening strategy for RHD detection using HAND.
  
  
  METHODS
  In this prospective study, STAND (GE Vivid q or i or Philips CX-50) was performed in five schools in Gulu, Uganda; a random subset plus all children with detectable mitral regurgitation or aortic insufficiency also underwent HAND (GE Vscan). Borderline or definite RHD cases were defined by 2012 World Heart Federation criteria on STAND images, by two experienced readers. HAND studies were reviewed by cardiologists blinded to STAND results. Single and combined HAND parameters were evaluated to determine the simplified screening strategy that maximized sensitivity and specificity for case detection.
  
  
  RESULTS
  In 1,439 children (mean age, 10.8 ± 2.6 years; 47% male) with HAND and STAND studies, morphologic criteria and the presence of any mitral regurgitation by HAND had poor specificity. The presence of aortic insufficiency was specific but not sensitive. Combined criteria of mitral regurgitation jet length ≥ 1.5 cm or any aortic insufficiency best balanced sensitivity (73.3%) and specificity (82.4%), with excellent sensitivity for definite RHD (97.9%). With a prevalence of 4% and subsequent STAND screening of positive HAND studies, this would reduce STAND studies by 80% from a STAND-based screening strategy.
  
  
  CONCLUSIONS
  In resource-limited settings, HAND with simplified criteria can detect RHD with good sensitivity and specificity and decrease the need for standard echocardiography. Further study is needed to validate screening by local practitioners and long-term outcomes.
authors: University of Michigan Congenital Heart Center, Ann Arbor, Michigan. Electronic address: jimmyl@umich.edu.
authors: Jimmy C
authors: JC
authors: Lu
authors: Children's National Medical Center, Washington, District of Columbia.
authors: Craig
authors: C
authors: Sable
authors: University of Michigan Congenital Heart Center, Ann Arbor, Michigan.
authors: Gregory J
authors: GJ
authors: Ensing
authors: University of Michigan Congenital Heart Center, Ann Arbor, Michigan.
authors: Catherine
authors: C
authors: Webb
authors: Children's National Medical Center, Washington, District of Columbia.
authors: Janet
authors: J
authors: Scheel
authors: Uganda Heart Institute, Kampala, Uganda.
authors: Twalib
authors: T
authors: Aliku
authors: Uganda Heart Institute, Kampala, Uganda.
authors: Peter
authors: P
authors: Lwabi
authors: Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee.
authors: Justin
authors: J
authors: Godown
authors: Children's National Medical Center, Washington, District of Columbia.
authors: Andrea
authors: A
authors: Beaton
mesh_terms: D000465:Algorithms; D002648:Child; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008904:Miniaturization; D056888:Patient Positioning / Q000379:methods*; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014454:Uganda
keywords: Aortic insufficiency; Handheld echocardiography; Mitral regurgitation; Rheumatic heart disease