Echocardiographic screening in a resource poor setting

Borderline rheumatic heart disease could be a normal variant

Samantha Colquhoun, Joseph Kado, Bo (Boglarka) Remenyi, N Wilson, Jonathan Carapetis, Andrew Steer

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Objective: To estimate the echocardiography confirmed prevalence of rheumatic heart disease (RHD) in school children in Fiji.

    Design: 
    Cross-sectional observational study.

    Setting: 
    Ten primary schools in Fiji.

    Patients: 
    School children aged 5–14 years.

    Interventions: 
    Each child had an echocardiogram performed by an echocardiographic technician subsequently read by a paediatric cardiologist not involved with field screening, and auscultation performed by a paediatrician.

    Main outcome measures: 
    Echocardiographic criteria for RHD diagnosis were based on those previously published by the National Institutes of Health (NIH) and World Health Organization (WHO), and data were also analyzed using the new World Heart Federation (WHF) criteria. Prevalence figures were calculated with binomial 95% confidence intervals.

    Results: 
    Using the modified NIH/WHO criteria the prevalence of definite RHD prevalence was 7.2 cases per 1000 (95% CI 3.7–12.5), and the prevalence of probable RHD 28.2 cases per 1000 (95% CI 20.8–37.3). By applying the WHF criteria the prevalence of definite and borderline RHD was 8.4 cases per 1000 (95% CI 4.6–14.1) and 10.8 cases per 1000 (95% CI 6.4–17.0) respectively. Definite RHD was more common in females (OR 5.1, 95% CI 1.1–48.3) and in children who attended school in a rural location (OR 2.3, 95% CI 0.6–13.50). Auscultation was poorly sensitive compared to echocardiography (30%).

    Conclusion: 
    There is a high burden of undiagnosed RHD in Fiji. Auscultation is poorly sensitive when compared to echocardiography in the detection of asymptomatic RHD. The results of this study highlight the importance of the use of highly sensitive and specific diagnostic criteria for echocardiography diagnosis of RHD.
    Original languageEnglish
    Pages (from-to)284-289
    Number of pages6
    JournalInternational Journal of Cardiology
    Volume173
    Issue number2
    DOIs
    Publication statusPublished - 1 May 2014

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    Rheumatic Heart Disease
    Fiji
    Auscultation
    Echocardiography
    National Institutes of Health (U.S.)
    Observational Studies
    Cross-Sectional Studies
    Outcome Assessment (Health Care)
    Confidence Intervals
    Pediatrics
    9-deaza-9-(3-thienylmethyl)guanine

    Cite this

    Colquhoun, Samantha ; Kado, Joseph ; Remenyi, Bo (Boglarka) ; Wilson, N ; Carapetis, Jonathan ; Steer, Andrew. / Echocardiographic screening in a resource poor setting : Borderline rheumatic heart disease could be a normal variant. In: International Journal of Cardiology. 2014 ; Vol. 173, No. 2. pp. 284-289.
    @article{b6b4fab8dcfd4d05a222a74d2bdec34d,
    title = "Echocardiographic screening in a resource poor setting: Borderline rheumatic heart disease could be a normal variant",
    abstract = "Objective: To estimate the echocardiography confirmed prevalence of rheumatic heart disease (RHD) in school children in Fiji.Design: Cross-sectional observational study.Setting: Ten primary schools in Fiji.Patients: School children aged 5–14 years.Interventions: Each child had an echocardiogram performed by an echocardiographic technician subsequently read by a paediatric cardiologist not involved with field screening, and auscultation performed by a paediatrician.Main outcome measures: Echocardiographic criteria for RHD diagnosis were based on those previously published by the National Institutes of Health (NIH) and World Health Organization (WHO), and data were also analyzed using the new World Heart Federation (WHF) criteria. Prevalence figures were calculated with binomial 95{\%} confidence intervals.Results: Using the modified NIH/WHO criteria the prevalence of definite RHD prevalence was 7.2 cases per 1000 (95{\%} CI 3.7–12.5), and the prevalence of probable RHD 28.2 cases per 1000 (95{\%} CI 20.8–37.3). By applying the WHF criteria the prevalence of definite and borderline RHD was 8.4 cases per 1000 (95{\%} CI 4.6–14.1) and 10.8 cases per 1000 (95{\%} CI 6.4–17.0) respectively. Definite RHD was more common in females (OR 5.1, 95{\%} CI 1.1–48.3) and in children who attended school in a rural location (OR 2.3, 95{\%} CI 0.6–13.50). Auscultation was poorly sensitive compared to echocardiography (30{\%}).Conclusion: There is a high burden of undiagnosed RHD in Fiji. Auscultation is poorly sensitive when compared to echocardiography in the detection of asymptomatic RHD. The results of this study highlight the importance of the use of highly sensitive and specific diagnostic criteria for echocardiography diagnosis of RHD.",
    author = "Samantha Colquhoun and Joseph Kado and Remenyi, {Bo (Boglarka)} and N Wilson and Jonathan Carapetis and Andrew Steer",
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    Echocardiographic screening in a resource poor setting : Borderline rheumatic heart disease could be a normal variant. / Colquhoun, Samantha; Kado, Joseph; Remenyi, Bo (Boglarka); Wilson, N; Carapetis, Jonathan; Steer, Andrew.

    In: International Journal of Cardiology, Vol. 173, No. 2, 01.05.2014, p. 284-289.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Echocardiographic screening in a resource poor setting

    T2 - Borderline rheumatic heart disease could be a normal variant

    AU - Colquhoun, Samantha

    AU - Kado, Joseph

    AU - Remenyi, Bo (Boglarka)

    AU - Wilson, N

    AU - Carapetis, Jonathan

    AU - Steer, Andrew

    PY - 2014/5/1

    Y1 - 2014/5/1

    N2 - Objective: To estimate the echocardiography confirmed prevalence of rheumatic heart disease (RHD) in school children in Fiji.Design: Cross-sectional observational study.Setting: Ten primary schools in Fiji.Patients: School children aged 5–14 years.Interventions: Each child had an echocardiogram performed by an echocardiographic technician subsequently read by a paediatric cardiologist not involved with field screening, and auscultation performed by a paediatrician.Main outcome measures: Echocardiographic criteria for RHD diagnosis were based on those previously published by the National Institutes of Health (NIH) and World Health Organization (WHO), and data were also analyzed using the new World Heart Federation (WHF) criteria. Prevalence figures were calculated with binomial 95% confidence intervals.Results: Using the modified NIH/WHO criteria the prevalence of definite RHD prevalence was 7.2 cases per 1000 (95% CI 3.7–12.5), and the prevalence of probable RHD 28.2 cases per 1000 (95% CI 20.8–37.3). By applying the WHF criteria the prevalence of definite and borderline RHD was 8.4 cases per 1000 (95% CI 4.6–14.1) and 10.8 cases per 1000 (95% CI 6.4–17.0) respectively. Definite RHD was more common in females (OR 5.1, 95% CI 1.1–48.3) and in children who attended school in a rural location (OR 2.3, 95% CI 0.6–13.50). Auscultation was poorly sensitive compared to echocardiography (30%).Conclusion: There is a high burden of undiagnosed RHD in Fiji. Auscultation is poorly sensitive when compared to echocardiography in the detection of asymptomatic RHD. The results of this study highlight the importance of the use of highly sensitive and specific diagnostic criteria for echocardiography diagnosis of RHD.

    AB - Objective: To estimate the echocardiography confirmed prevalence of rheumatic heart disease (RHD) in school children in Fiji.Design: Cross-sectional observational study.Setting: Ten primary schools in Fiji.Patients: School children aged 5–14 years.Interventions: Each child had an echocardiogram performed by an echocardiographic technician subsequently read by a paediatric cardiologist not involved with field screening, and auscultation performed by a paediatrician.Main outcome measures: Echocardiographic criteria for RHD diagnosis were based on those previously published by the National Institutes of Health (NIH) and World Health Organization (WHO), and data were also analyzed using the new World Heart Federation (WHF) criteria. Prevalence figures were calculated with binomial 95% confidence intervals.Results: Using the modified NIH/WHO criteria the prevalence of definite RHD prevalence was 7.2 cases per 1000 (95% CI 3.7–12.5), and the prevalence of probable RHD 28.2 cases per 1000 (95% CI 20.8–37.3). By applying the WHF criteria the prevalence of definite and borderline RHD was 8.4 cases per 1000 (95% CI 4.6–14.1) and 10.8 cases per 1000 (95% CI 6.4–17.0) respectively. Definite RHD was more common in females (OR 5.1, 95% CI 1.1–48.3) and in children who attended school in a rural location (OR 2.3, 95% CI 0.6–13.50). Auscultation was poorly sensitive compared to echocardiography (30%).Conclusion: There is a high burden of undiagnosed RHD in Fiji. Auscultation is poorly sensitive when compared to echocardiography in the detection of asymptomatic RHD. The results of this study highlight the importance of the use of highly sensitive and specific diagnostic criteria for echocardiography diagnosis of RHD.

    U2 - 10.1016/j.ijcard.2014.03.004

    DO - 10.1016/j.ijcard.2014.03.004

    M3 - Article

    VL - 173

    SP - 284

    EP - 289

    JO - International Journal of Cardiology

    JF - International Journal of Cardiology

    SN - 0167-5273

    IS - 2

    ER -