title: Echocardiographic screening for rheumatic heart disease-some answers, but questions remain.
abstract: Despite being preventable, rheumatic heart disease (RHD) remains a significant global cause of cardiovascular disease. Echocardiographic screening for early detection of RHD has the potential to enable timely commencement of treatment (secondary prophylaxis) to halt progression to severe valvular disease. However, a number of issues remain to be addressed regarding its feasibility. The natural history of Definite RHD without a prior history of acute rheumatic fever (ARF) and Borderline RHD are both unclear. Even if they are variants of RHD it is not known whether secondary antibiotic prophylaxis will prevent disease progression as it does in "traditionally" diagnosed RHD. False positives can also have a detrimental impact on individuals and their families as well as place substantial burdens on health care systems. Recent research suggests that handheld echocardiography (HAND) may offer a cheaper and more convenient alternative to standard portable echocardiography (STAND) in RHD screening. However, while HAND is sensitive for the detection of Definite RHD, it is less sensitive for Borderline RHD and is relatively poor at detecting mitral stenosis (MS). Given its attendant limited specificity, potential cases detected with HAND would require re-examination by standard echocardiography. For now, echocardiographic screening for RHD should remain a subject of research rather than routine health care.
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia.
authors.forename: Marc G W
authors.initials: MG
authors.lastname: Rémond
authors.affiliation: Baker IDI Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia.
authors.forename: Graeme P
authors.initials: GP
authors.lastname: Maguire
keywords: Rheumatic heart disease (RHD); echocardiography; prophylaxis; screening
references.citation: BMC Cardiovasc Disord. 2013 Nov 01;13:95
references.pmid: 24180350
references.citation: Lancet Infect Dis. 2005 Nov;5(11):685-94
references.pmid: 16253886
references.citation: Cardiol Young. 2011 Aug;21(4):436-43
references.pmid: 21450132
references.citation: Heart. 2005 Aug;91(8):1019-22
references.pmid: 16020588
references.citation: Aust N Z J Med. 1997 Dec;27(6):691-7
references.pmid: 9483238
references.citation: Ann Pediatr Cardiol. 2011 Jan;4(1):4-12
references.pmid: 21677798
references.citation: Lancet Glob Health. 2014 Dec;2(12):e717-26
references.pmid: 25433627
references.citation: Intern Med J. 2013 Apr;43(4):386-93
references.pmid: 22646671
references.citation: Pediatrics. 2015 Apr;135(4):e939-44
references.pmid: 25780068
references.citation: Med J Aust. 2013 Aug 5;199(3):196-9
references.pmid: 23909543
references.citation: Cardiovasc J Afr. 2013 Mar;24(2):28-33
references.pmid: 23612950
references.citation: Med J Aust. 1996 Feb 5;164(3):146-9
references.pmid: 8628132
references.citation: Nat Rev Cardiol. 2012 Feb 28;9(5):297-309
references.pmid: 22371105
references.citation: J Paediatr Child Health. 2015 Jul;51(7):682-8
references.pmid: 25756837
references.citation: N Engl J Med. 2007 Aug 2;357(5):470-6
references.pmid: 17671255
references.citation: Int J Cardiol. 2013 Sep 30;168(2):888-91
references.pmid: 23245622
references.citation: Pediatr Clin North Am. 2009 Dec;56(6):1401-19
references.pmid: 19962028
references.citation: Int J Gen Med. 2013 May 23;6:375-81
references.pmid: 23723716
references.citation: Circulation. 2009 Aug 25;120(8):663-8
references.pmid: 19667239
references.citation: J Paediatr Child Health. 2013 Apr;49(4):297-302
references.pmid: 23551836
references.citation: Am J Cardiol. 2010 Jun 15;105(12 ):1809-14
references.pmid: 20538135
references.citation: Heart. 2011 Dec;97(24):2018-22
references.pmid: 22076022
references.citation: Circulation. 2012 Jun 26;125(25):3127-32
references.pmid: 22626741
references.citation: Pediatr Cardiol. 2014 Oct;35(7):1259-67
references.pmid: 24827080
references.citation: Curr Opin Pediatr. 2015 Feb;27(1):116-23
references.pmid: 25490689
references.citation: Nat Clin Pract Cardiovasc Med. 2008 Jul;5(7):411-7
references.pmid: 18398402
references.citation: J Paediatr Child Health. 2013 Feb;49(2):109-14
references.pmid: 23347199
references.citation: Circulation. 2014 May 13;129(19):1953-61
references.pmid: 24622384