Towards early detection of rheumatic heart disease in the young
: international standardisation of echocardiographic diagnostic criteria

  • Boglarka Remenyi

    Student thesis: Doctor of Philosophy (PhD) - CDU


    Some 34 million people in the word have Rheumatic Heart Disease (RHD) a long-term sequela of Acute Rheumatic Fever (ARF). RHD is disease of poverty and social disadvantage. The majority of individuals with RHD do not have a documented history of ARF and thereby miss out on costeffective secondary prevention strategies. Patients with RHD present late with complications of RHD and die at a young age due to lack of access to cardiosurgical services. Early diagnosis of RHD, may be it in a clinical setting or as part of systematic screening programs, could allow for case detection at a stage of illness when secondary prophylaxis could have a greater chance of success in preventing morbidity and mortality.

    The thesis starts by systematically reviewing barriers to RHD control and setting the first global target towards elimination of RHD as public health agenda. Then it assesses the knowledge gap around timing of life-saving cardiosurgical strategies and about their long-term outcomes in children with RHD.

    At the commencement of this thesis, no evidence-based guidelines existed to define mild RHD in individuals without a history of ARF. We knew that clinical diagnosis of RHD based on auscultation was neither sensitive or specific. Echocardiography is a noninvasive diagnostic tool that has shown to be a vital for cardiac diagnoses, yet no criteria on how to distinguish normal echocardiographic findings from mild RHD existed.

    This thesis highlights these gaps and presents the contemporary long-term outcomes of cardiac surgery in children and argues for early detection of RHD using technology-based solutions –echocardiography. It presents the 2012 World Heart Federation (WHF) evidence-based guidelines for echocardiographic diagnosis of RHD to replace the stethoscope. The guidelines aim to facilitate early case detection of individuals with RHD without a prior history of ARF and to allow for standardised reporting on the global stage. This thesis contains the validation study that assesses the reliability of the WHF criteria and then moves to abbreviated protocols that could be implemented on cheaper hand-held echocardiography machines and performed by minimally trained health workers in resource-poor settings where RHD is most prevalent. The thesis concludes by assessing if RHD fulfils the public health requirements of a disease suitable for screening.
    Date of AwardMar 2019
    Original languageEnglish
    SupervisorJonathan Carapetis (Supervisor) & Anne Chang (Supervisor)

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