Single-View Echocardiography by Nonexpert Practitioners to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy

Joshua R. Francis, Gillian A. Whalley, Alex Kaethner, Helen Fairhurst, Hilary Hardefeldt, Benjamin Reeves, Benjamin Auld, James Marangou, Ari Horton, Gavin Wheaton, Terry Robertson, Chelsea Ryan, Shannon Brown, Greg Smith, Januario Dos Santos, Ricardo Flavio, Karolina Embaum, Mario Da Graca Noronha, Sonia Lopes Belo, Carla Madeira SantosMaria Georginha Dos Santos, Jose Cabral, Ivonia Do Rosario, Jessica Harries, Laura A. Francis, Anthony D.K. Draper, Christian L. James, Kimberly Davis, Jennifer Yan, Alice Mitchell, Ines Da Silva Almeida, Daniel Engelman, Kathryn V. Roberts, Anna P. Ralph, Bo Remenyi

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Background: Echocardiographic screening can detect asymptomatic cases of rheumatic heart disease (RHD), facilitating access to treatment. Barriers to implementation of echocardiographic screening include the requirement for expensive equipment and expert practitioners. We aimed to evaluate the diagnostic accuracy of an abbreviated echocardiographic screening protocol (single parasternal-long-axis view with a sweep of the heart) performed by briefly trained, nonexpert practitioners using handheld ultrasound devices. 

Methods: Participants aged 5 to 20 years in Timor-Leste and the Northern Territory of Australia had 2 echocardiograms: one performed by an expert echocardiographer using a GE Vivid I or Vivid Q portable ultrasound device (reference test), and one performed by a nonexpert practitioner using a GE Vscan handheld ultrasound device (index test). The accuracy of the index test, compared with the reference test, for identifying cases with definite or borderline RHD was determined. 

Results: There were 3111 enrolled participants; 2573 had both an index test and reference test. Median age was 12 years (interquartile range, 10-15); 58.2% were female. Proportion with definite or borderline RHD was 5.52% (95% CI, 4.70-6.47); proportion with definite RHD was 3.23% (95% CI, 2.61-3.98). Compared with the reference test, sensitivity of the index test for definite or borderline RHD was 70.4% (95% CI, 62.2-77.8), specificity was 78.1% (95% CI, 76.4-79.8). 

Conclusions: Nonexpert practitioners can be trained to perform single parasternal-long-axis view with a sweep of the heart echocardiography. However, the specificity and sensitivity are inadequate for echocardiographic screening. Improved training for nonexpert practitioners should be investigated.

Original languageEnglish
Article numbere011790
Pages (from-to)1-10
Number of pages10
JournalCirculation. Cardiovascular imaging
Issue number8
Publication statusPublished - Aug 2021


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