Low-Cost Echocardiography for Rheumatic Heart Disease Screening

F. Bruder Stapleton, MD reviewing Godown J et al. Pediatrics 2015 Apr 1.

Handheld echocardiography was superior to auscultation in identifying rheumatic heart disease and aortic insufficiency among Ugandan schoolchildren.

Rheumatic heart disease (RHD) continues to be a major health problem in developing countries. In detection of RHD, standard echocardiography (STAND) is known to be superior to cardiac auscultation, but its cost is significant. To determine whether a lower-cost option, handheld echocardiography (HAND), performs better than standard auscultation, researchers compared diagnostic performance in an observational study involving 4773 Ugandan schoolchildren.

All children underwent screening with STAND, which was considered the gold standard test. Among 1317 children who underwent all three tests (mean age, 10.8 years), STAND identified 45 children with definite RHD and 126 with borderline RHD. The sensitivity of HAND for detection of definite or borderline RHD was 97.8%, compared with 22.2% for auscultation (P<0.0001); specificity was similar between tests (87.3% and 91.2%, respectively). HAND had a greater sensitivity compared with auscultation for detecting both mitral regurgitation and aortic regurgitation, as well as mitral stenosis. The positive-predictive value of HAND was approximately three times greater compared with auscultation. HAND had a 99% negative-predictive value for RHD.

CITATION(S):

Godown J et al. Handheld echocardiography versus auscultation for detection of rheumatic heart disease. Pediatrics 2015 Apr 1; 135:e939.