Single Parasternal-Long-Axis-View-Sweep Screening Echocardiographic Protocol to Detect Rheumatic Heart Disease

A Prospective Study of Diagnostic Accuracy

B. Remenyi, K. Davis, A. Draper, N. Bayley, E. Paratz, B. Reeves, A. Appelbe, G. Wheaton, I. T. da Silva Almeida, J. dos Santos, J. Carapetis, J. R. Francis

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Echocardiographic screening in school-aged children can detect rheumatic heart disease (RHD) prior to the manifestation of symptoms of heart failure. The challenge is making this practical and affordable on a global scale. This study aims to evaluate the diagnostic utility of an ultra-abbreviated echocardiographic screening protocol involving a single parasternal-long-axis-view-sweep of the heart (SPLASH) in two dimensional (2D) and colour Doppler imaging (index test).

    Methods: This prospective study of diagnostic accuracy compared the diagnostic utility of the index screening test with a comprehensive reference test (standard echocardiographic screening protocols) as per World Heart Federation (WHF) echocardiographic criteria. School students in Timor-Leste aged 5–20 years were enrolled. Both index and reference test images were acquired by cardiologists on Vivid I or Q machines (GE Healthcare, Marlborough, MA, USA).

    Results: A total of 1,365 participants were screened; median age was 11 years. The estimated prevalence of definite and borderline RHD was 35.2 per 1,000. Congenital heart disease was identified in 11 children (0.8%) with two needing cardiac surgery. Abnormal SPLASH views were found in 109/1365 (7.99%). No cases of RHD or significant congenital heart disease were missed. Sensitivity and specificity of the abbreviated protocol for detecting RHD were 1.0 and 0.95 respectively.

    Conclusions: A simplified echocardiography screening protocol using SPLASH is highly sensitive and specific and could significantly improve the efficiency of RHD screening. It has the potential to expedite training of health workers whilst protecting the modesty of students.

    Original languageEnglish
    Pages (from-to)1-8
    Number of pages8
    JournalHeart Lung and Circulation
    DOIs
    Publication statusE-pub ahead of print - 11 Jun 2019

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    Rheumatic Heart Disease
    Prospective Studies
    Heart Diseases
    Students
    Thoracic Surgery
    Echocardiography
    Heart Failure
    Color
    Delivery of Health Care
    Sensitivity and Specificity
    Health

    Cite this

    Remenyi, B. ; Davis, K. ; Draper, A. ; Bayley, N. ; Paratz, E. ; Reeves, B. ; Appelbe, A. ; Wheaton, G. ; da Silva Almeida, I. T. ; dos Santos, J. ; Carapetis, J. ; Francis, J. R. / Single Parasternal-Long-Axis-View-Sweep Screening Echocardiographic Protocol to Detect Rheumatic Heart Disease : A Prospective Study of Diagnostic Accuracy. In: Heart Lung and Circulation. 2019 ; pp. 1-8.
    @article{5ca3f01363db4fd083090a03e9347826,
    title = "Single Parasternal-Long-Axis-View-Sweep Screening Echocardiographic Protocol to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy",
    abstract = "Background: Echocardiographic screening in school-aged children can detect rheumatic heart disease (RHD) prior to the manifestation of symptoms of heart failure. The challenge is making this practical and affordable on a global scale. This study aims to evaluate the diagnostic utility of an ultra-abbreviated echocardiographic screening protocol involving a single parasternal-long-axis-view-sweep of the heart (SPLASH) in two dimensional (2D) and colour Doppler imaging (index test). Methods: This prospective study of diagnostic accuracy compared the diagnostic utility of the index screening test with a comprehensive reference test (standard echocardiographic screening protocols) as per World Heart Federation (WHF) echocardiographic criteria. School students in Timor-Leste aged 5–20 years were enrolled. Both index and reference test images were acquired by cardiologists on Vivid I or Q machines (GE Healthcare, Marlborough, MA, USA). Results: A total of 1,365 participants were screened; median age was 11 years. The estimated prevalence of definite and borderline RHD was 35.2 per 1,000. Congenital heart disease was identified in 11 children (0.8{\%}) with two needing cardiac surgery. Abnormal SPLASH views were found in 109/1365 (7.99{\%}). No cases of RHD or significant congenital heart disease were missed. Sensitivity and specificity of the abbreviated protocol for detecting RHD were 1.0 and 0.95 respectively. Conclusions: A simplified echocardiography screening protocol using SPLASH is highly sensitive and specific and could significantly improve the efficiency of RHD screening. It has the potential to expedite training of health workers whilst protecting the modesty of students.",
    keywords = "Children, Echocardiography, Rheumatic heart disease, Screening",
    author = "B. Remenyi and K. Davis and A. Draper and N. Bayley and E. Paratz and B. Reeves and A. Appelbe and G. Wheaton and {da Silva Almeida}, {I. T.} and {dos Santos}, J. and J. Carapetis and Francis, {J. R.}",
    year = "2019",
    month = "6",
    day = "11",
    doi = "10.1016/j.hlc.2019.02.196",
    language = "English",
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    Remenyi, B, Davis, K, Draper, A, Bayley, N, Paratz, E, Reeves, B, Appelbe, A, Wheaton, G, da Silva Almeida, IT, dos Santos, J, Carapetis, J & Francis, JR 2019, 'Single Parasternal-Long-Axis-View-Sweep Screening Echocardiographic Protocol to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy', Heart Lung and Circulation, pp. 1-8. https://doi.org/10.1016/j.hlc.2019.02.196

    Single Parasternal-Long-Axis-View-Sweep Screening Echocardiographic Protocol to Detect Rheumatic Heart Disease : A Prospective Study of Diagnostic Accuracy. / Remenyi, B.; Davis, K.; Draper, A.; Bayley, N.; Paratz, E.; Reeves, B.; Appelbe, A.; Wheaton, G.; da Silva Almeida, I. T.; dos Santos, J.; Carapetis, J.; Francis, J. R.

    In: Heart Lung and Circulation, 11.06.2019, p. 1-8.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Single Parasternal-Long-Axis-View-Sweep Screening Echocardiographic Protocol to Detect Rheumatic Heart Disease

    T2 - A Prospective Study of Diagnostic Accuracy

    AU - Remenyi, B.

    AU - Davis, K.

    AU - Draper, A.

    AU - Bayley, N.

    AU - Paratz, E.

    AU - Reeves, B.

    AU - Appelbe, A.

    AU - Wheaton, G.

    AU - da Silva Almeida, I. T.

    AU - dos Santos, J.

    AU - Carapetis, J.

    AU - Francis, J. R.

    PY - 2019/6/11

    Y1 - 2019/6/11

    N2 - Background: Echocardiographic screening in school-aged children can detect rheumatic heart disease (RHD) prior to the manifestation of symptoms of heart failure. The challenge is making this practical and affordable on a global scale. This study aims to evaluate the diagnostic utility of an ultra-abbreviated echocardiographic screening protocol involving a single parasternal-long-axis-view-sweep of the heart (SPLASH) in two dimensional (2D) and colour Doppler imaging (index test). Methods: This prospective study of diagnostic accuracy compared the diagnostic utility of the index screening test with a comprehensive reference test (standard echocardiographic screening protocols) as per World Heart Federation (WHF) echocardiographic criteria. School students in Timor-Leste aged 5–20 years were enrolled. Both index and reference test images were acquired by cardiologists on Vivid I or Q machines (GE Healthcare, Marlborough, MA, USA). Results: A total of 1,365 participants were screened; median age was 11 years. The estimated prevalence of definite and borderline RHD was 35.2 per 1,000. Congenital heart disease was identified in 11 children (0.8%) with two needing cardiac surgery. Abnormal SPLASH views were found in 109/1365 (7.99%). No cases of RHD or significant congenital heart disease were missed. Sensitivity and specificity of the abbreviated protocol for detecting RHD were 1.0 and 0.95 respectively. Conclusions: A simplified echocardiography screening protocol using SPLASH is highly sensitive and specific and could significantly improve the efficiency of RHD screening. It has the potential to expedite training of health workers whilst protecting the modesty of students.

    AB - Background: Echocardiographic screening in school-aged children can detect rheumatic heart disease (RHD) prior to the manifestation of symptoms of heart failure. The challenge is making this practical and affordable on a global scale. This study aims to evaluate the diagnostic utility of an ultra-abbreviated echocardiographic screening protocol involving a single parasternal-long-axis-view-sweep of the heart (SPLASH) in two dimensional (2D) and colour Doppler imaging (index test). Methods: This prospective study of diagnostic accuracy compared the diagnostic utility of the index screening test with a comprehensive reference test (standard echocardiographic screening protocols) as per World Heart Federation (WHF) echocardiographic criteria. School students in Timor-Leste aged 5–20 years were enrolled. Both index and reference test images were acquired by cardiologists on Vivid I or Q machines (GE Healthcare, Marlborough, MA, USA). Results: A total of 1,365 participants were screened; median age was 11 years. The estimated prevalence of definite and borderline RHD was 35.2 per 1,000. Congenital heart disease was identified in 11 children (0.8%) with two needing cardiac surgery. Abnormal SPLASH views were found in 109/1365 (7.99%). No cases of RHD or significant congenital heart disease were missed. Sensitivity and specificity of the abbreviated protocol for detecting RHD were 1.0 and 0.95 respectively. Conclusions: A simplified echocardiography screening protocol using SPLASH is highly sensitive and specific and could significantly improve the efficiency of RHD screening. It has the potential to expedite training of health workers whilst protecting the modesty of students.

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    KW - Echocardiography

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