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Echocardiographic screening for rheumatic heart disease-some answers, but questions remain
Marc G W Rémond1, Graeme P Maguire1
1Baker IDI Heart and Diabetes Institute, Melbourne, Victoria 3004, Australia.
Insights
Rheumatic heart disease (RHD) screening using handheld echocardiography shows promise but requires further research. Current methods face challenges with accuracy and diagnosing certain RHD forms, necessitating continued investigation before widespread clinical use.
Area of Science:
- Cardiology
- Public Health
- Medical Imaging
Background:
- Rheumatic heart disease (RHD) is a preventable yet significant global cardiovascular disease.
- Early echocardiographic screening can facilitate secondary prophylaxis to halt RHD progression.
- Feasibility and diagnostic nuances of RHD screening require further investigation.
Purpose of the Study:
- To evaluate the feasibility of echocardiographic screening for rheumatic heart disease (RHD).
- To assess the utility of handheld echocardiography (HAND) as a screening tool for RHD.
- To address uncertainties regarding the natural history and treatment of early-stage RHD.
Main Methods:
- Review of current research on echocardiographic screening for RHD.
- Comparison of handheld (HAND) versus standard portable echocardiography (STAND) for RHD detection.
- Analysis of diagnostic accuracy for Definite RHD, Borderline RHD, and mitral stenosis (MS).
Main Results:
- Handheld echocardiography (HAND) shows sensitivity for Definite RHD but is less sensitive for Borderline RHD and mitral stenosis (MS).
- False positives in screening can negatively impact patients and healthcare systems.
- Potential HAND-detected cases require confirmation with standard echocardiography due to limited specificity.
Conclusions:
- Echocardiographic screening for RHD holds potential for early detection and intervention.
- Handheld echocardiography (HAND) may be a cost-effective alternative but has limitations in sensitivity and specificity.
- Further research is needed to refine screening protocols and confirm the efficacy of secondary prophylaxis in all RHD variants before routine implementation.
Abstract:
Despite being preventable, rheumatic heart disease (RHD) remains a significant global cause of cardiovascular disease. Echocardiographic screening for early detection of RHD has the potential to enable timely commencement of treatment (secondary prophylaxis) to halt progression to severe valvular disease. However, a number of issues remain to be addressed regarding its feasibility. The natural history of Definite RHD without a prior history of acute rheumatic fever (ARF) and Borderline RHD are both unclear. Even if they are variants of RHD it is not known whether secondary antibiotic prophylaxis will prevent disease progression as it does in "traditionally" diagnosed RHD. False positives can also have a detrimental impact on individuals and their families as well as place substantial burdens on health care systems. Recent research suggests that handheld echocardiography (HAND) may offer a cheaper and more convenient alternative to standard portable echocardiography (STAND) in RHD screening. However, while HAND is sensitive for the detection of Definite RHD, it is less sensitive for Borderline RHD and is relatively poor at detecting mitral stenosis (MS). Given its attendant limited specificity, potential cases detected with HAND would require re-examination by standard echocardiography. For now, echocardiographic screening for RHD should remain a subject of research rather than routine health care.
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