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Echocardiographic screening in a resource poor setting: Borderline rheumatic heart disease could be a normal variant

Colquhoun, Samantha M., Kado, Joseph H., Remenyi, Bo, Wilson, N. J., Carapetis, Jonathan R. and Steer, Andrew C. (2014). Echocardiographic screening in a resource poor setting: Borderline rheumatic heart disease could be a normal variant. International Journal of Cardiology,173(2):284-289.

Document type: Journal Article
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IRMA ID cmartelxPUB168
Title Echocardiographic screening in a resource poor setting: Borderline rheumatic heart disease could be a normal variant
Author Colquhoun, Samantha M.
Kado, Joseph H.
Remenyi, Bo
Wilson, N. J.
Carapetis, Jonathan R.
Steer, Andrew C.
Journal Name International Journal of Cardiology
Publication Date 2014
Volume Number 173
Issue Number 2
ISSN 0167-5273   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84898839947
Start Page 284
End Page 289
Total Pages 56
Place of Publication Ireland
Publisher Elsevier Ireland Ltd.
HERDC Category C1 - Journal Article (DIISR)
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.
Keywords Rheumatic heart disease
Prevalence
Echocardiography
Fiji
Epidemiology
Developing country
DOI http://dx.doi.org/10.1016/j.ijcard.2014.03.004   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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