title: Valvular Regurgitation Using Portable Echocardiography in a Healthy Student Population: Implications for Rheumatic Heart Disease Screening.
abstract: BACKGROUND
  There is increasing use of portable echocardiography as a screening test for rheumatic heart disease (RHD). The prevalence of valvular regurgitation in healthy populations as determined using portable echocardiography has not been well defined. Minimal echocardiographic criteria for RHD have recently been clarified, but the overlap of normal and abnormal valvular regurgitation warrants further study. The aim of this study was to determine the spectrum of echocardiographic findings using portable echocardiography in children from a population with low prevalence of RHD.
  
  
  METHODS
  Screening echocardiography was conducted in 396 healthy students aged 10 to 12 years using portable echocardiographic equipment. Echocardiograms were assessed according to 2012 World Heart Federation criteria for RHD. The prevalence of physiologic valvular regurgitation was compared with that found in previous studies of children using large-platform machines.
  
  
  RESULTS
  Physiologic mitral regurgitation (MR) was present in 14.9% of subjects (95% CI, 11.7%-18.7%) and pathologic MR in 1.3% (95% CI, 0.6%-2.9%). Two percent (95% CI, 1.0%-3.9%) had physiologic aortic regurgitation, and none had pathologic aortic valve regurgitation. Physiologic tricuspid regurgitation was present in 72.7% of subjects (95% CI, 68.1%-76.9%) and physiologic pulmonary regurgitation in 89.6% (95% CI, 85.7%-91.8%). After cardiology review, no cases of definite RHD were found, but 0.5% of patients (95% CI, 0.1%-1.8%) had pathologic MR meeting World Heart Federation criteria for borderline RHD. Two percent (95% CI, 1.4%-4.6%) of the cohort had minor forms of congenital heart disease.
  
  
  CONCLUSIONS
  The spectrum of physiologic cardiac valvular regurgitation in healthy children as determined using portable echocardiography is described and is within the range of previous studies using large-platform echocardiographic equipment. The finding of two children with pathologic-grade MR, likely representing the upper limit of physiologic regurgitation, has implications for echocardiographic screening for RHD in high-prevalence regions.
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand; Paediatric Infectious Diseases, Starship Children's Hospital, Auckland, New Zealand. Electronic address: rwebb@adhb.govt.nz.
authors.forename: Rachel H
authors.initials: RH
authors.lastname: Webb
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: Tom L
authors.initials: TL
authors.lastname: Gentles
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: John W
authors.initials: JW
authors.lastname: Stirling
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: Clare
authors.initials: C
authors.lastname: O'Donnell
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland, New Zealand.
authors.forename: Nigel J
authors.initials: NJ
authors.lastname: Wilson
mesh_terms: D002648:Child; D015897:Comorbidity; D004452:Echocardiography / Q000295:instrumentation / Q000706:statistics & numerical data*; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000295:instrumentation / Q000706:statistics & numerical data*; D008904:Miniaturization; D009520:New Zealand / Q000453:epidemiology; D015203:Reproducibility of Results; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013334:Students / Q000706:statistics & numerical data
keywords: ARF; Echocardiography; Public health screening; RHD; Valvular regurgitation