TY - JOUR
T1 - Single-View Echocardiography by Nonexpert Practitioners to Detect Rheumatic Heart Disease
T2 - A Prospective Study of Diagnostic Accuracy
AU - Francis, Joshua R.
AU - Whalley, Gillian A.
AU - Kaethner, Alex
AU - Fairhurst, Helen
AU - Hardefeldt, Hilary
AU - Reeves, Benjamin
AU - Auld, Benjamin
AU - Marangou, James
AU - Horton, Ari
AU - Wheaton, Gavin
AU - Robertson, Terry
AU - Ryan, Chelsea
AU - Brown, Shannon
AU - Smith, Greg
AU - Dos Santos, Januario
AU - Flavio, Ricardo
AU - Embaum, Karolina
AU - Da Graca Noronha, Mario
AU - Lopes Belo, Sonia
AU - Madeira Santos, Carla
AU - Georginha Dos Santos, Maria
AU - Cabral, Jose
AU - Do Rosario, Ivonia
AU - Harries, Jessica
AU - Francis, Laura A.
AU - Draper, Anthony D.K.
AU - James, Christian L.
AU - Davis, Kimberly
AU - Yan, Jennifer
AU - Mitchell, Alice
AU - Da Silva Almeida, Ines
AU - Engelman, Daniel
AU - Roberts, Kathryn V.
AU - Ralph, Anna P.
AU - Remenyi, Bo
N1 - Publisher Copyright:
© 2021 Georg Thieme Verlag. All rights reserved.
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/8
Y1 - 2021/8
N2 - 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.
AB - 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.
KW - echocardiography
KW - rheumatic heart disease
KW - screening
UR - http://www.scopus.com/inward/record.url?scp=85113755249&partnerID=8YFLogxK
U2 - 10.1161/CIRCIMAGING.120.011790
DO - 10.1161/CIRCIMAGING.120.011790
M3 - Article
C2 - 34384239
AN - SCOPUS:85113755249
SN - 1941-9651
VL - 14
SP - 1
EP - 10
JO - Circulation. Cardiovascular imaging
JF - Circulation. Cardiovascular imaging
IS - 8
M1 - e011790
ER -
