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Handheld echocardiography versus auscultation for detection of rheumatic heart disease
Justin Godown1, Jimmy C Lu2, Andrea Beaton3
1Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee; justin.godown@vanderbilt.edu.
Insights
Handheld echocardiography (HAND) significantly improves the detection of rheumatic heart disease (RHD) compared to auscultation alone. This makes HAND a potentially cost-effective screening tool for RHD in resource-limited settings.
Area of Science:
- Cardiology
- Public Health
- Medical Devices
Background:
- Rheumatic heart disease (RHD) poses a significant global health challenge, particularly in developing nations.
- Routine RHD screening can enhance patient outcomes.
- Standard portable echocardiography (STAND) offers high sensitivity for RHD detection but is often too expensive for resource-limited areas.
Purpose of the Study:
- To evaluate the added value of handheld echocardiography (HAND) in identifying RHD compared to traditional auscultation.
- To assess the diagnostic performance of HAND for RHD screening in a resource-limited environment.
Main Methods:
- Schoolchildren in Gulu, Uganda, underwent RHD screening using STAND.
- Children identified with RHD or valve abnormalities, plus a control group, received HAND and auscultation.
- Echocardiograms were interpreted by cardiologists using World Heart Federation criteria, with STAND serving as the gold standard.
Main Results:
- Auscultation demonstrated low sensitivity for detecting RHD and valve disease.
- HAND significantly increased sensitivity for definite RHD (97.8% vs. 22.2%) and pathologic aortic insufficiency (81.8% vs. 13.6%) compared to auscultation.
- HAND showed improved sensitivity for borderline or definite RHD (78.4% vs. 16.4%).
Conclusions:
- Auscultation alone is insufficient for effective RHD screening.
- HAND substantially enhances RHD detection rates.
- HAND presents a viable and cost-effective strategy for RHD screening in underserved regions.
Background:
Rheumatic heart disease (RHD) remains a major public health concern in developing countries, and routine screening has the potential to improve outcomes. Standard portable echocardiography (STAND) is far more sensitive than auscultation for the detection of RHD but remains cost-prohibitive in resource-limited settings. Handheld echocardiography (HAND) is a lower-cost alternative. The purpose of this study was to assess the incremental value of HAND over auscultation to identify RHD.
Methods:
RHD screening was completed for schoolchildren in Gulu, Uganda, by using STAND performed by experienced echocardiographers. Any child with mitral or aortic regurgitation or stenosis plus a randomly selected group of children with normal STAND findings underwent HAND and auscultation. STAND and HAND studies were interpreted by 6 experienced cardiologists using the 2012 World Heart Federation criteria. Sensitivity and specificity of HAND and auscultation for the detection of RHD and pathologic mitral or aortic regurgitation were calculated by using STAND as the gold standard.
Results:
Of 4773 children who underwent screening with STAND, a subgroup of 1317 children underwent HAND and auscultation. Auscultation had uniformly poor sensitivity for the detection of RHD or valve disease. Sensitivity was significantly improved by using HAND compared with auscultation for the detection of definite RHD (97.8% vs 22.2%), borderline or definite RHD (78.4% vs 16.4%), and pathologic aortic insufficiency (81.8% vs 13.6%).
Conclusions:
Auscultation alone is a poor screening test for RHD. HAND significantly improves detection of RHD and may be a cost-effective screening strategy for RHD in resource-limited settings.
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