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Screening for subclinical rheumatic heart disease: addressing borderline disease in a real-world setting

Luke D Hunter1, Alfonso J K Pecoraro1, Anton F Doubell1

  • 1Division of Cardiology, Department of Medicine, Faculty of Medicine and Health Sciences, University of Stellenbosch and Tygerberg Academic Hospital, Francie van Zijl Drive, Tygerberg, 7505, Cape Town, South Africa.

European Heart Journal Open
|August 3, 2022
PubMed

Insights

Identifying inter-scallop separations (ISS) in mitral valve leaflets significantly reduces misclassification of rheumatic heart disease (RHD) in large-scale screening. This improves accuracy and efficiency for RHD detection programs.

Area of Science:

  • Cardiology
  • Echocardiography
  • Public Health

Background:

  • The World Heart Federation (WHF) criteria for rheumatic heart disease (RHD) create a large borderline category, hindering population-based screening.
  • Inter-scallop separations (ISS) of the posterior mitral valve leaflet, a normal variant, can cause mild mitral regurgitation (MR), leading to misclassification as borderline RHD.

Purpose of the Study:

  • To report findings from the Echo in Africa project, a large-scale RHD screening in South Africa.
  • To determine the proportion of borderline RHD cases that would be reclassified as normal with systematic identification of ISS-related MR.

Main Methods:

  • A prospective cross-sectional study screened 5255 students in underserved secondary schools using handheld ultrasound.
  • Abnormal handheld studies were followed by portable echocardiography.
  • Mechanistic evaluation was applied to isolated WHF 'pathological' MR cases to identify ISS-related MR.

Main Results:

  • 49 cases of definite RHD and 104 cases of borderline RHD were identified.
  • ISS-related MR was the cause in 70.5% of borderline RHD cases with isolated pathological MR.
  • Systematic identification of ISS-related MR markedly reduced the number of misclassified borderline RHD cases.

Conclusions:

  • Mechanistic evaluation identifying ISS-related MR significantly reduces misclassification in large-scale RHD screening.
  • Implementing ISS identification can decrease the cost and labor burden of RHD screening programs.
  • Accurate classification of RHD is crucial for effective public health interventions.
Abstract

Keywords:
Rheumatic heart diseaseScreening echocardiography

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