The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study

Abstract

HAND has good sensitivity and specificity for diagnosis of early RHD, performing best for definite RHD. Protocols for RHD detection utilizing HAND will need to include confirmation by STAND to avoid over-diagnosis. Strategies that evaluate simplified screening protocols and training of non-physicians hold promise for more wide spread deployment of HAND-based protocols.

Acute rheumatic fever and rheumatic heart disease in resource-limited settings

“…However, in the absence of ECHO, auscultation has low sensitivity for the detection of subclinical RHD and disease is more often diagnosed when patients present with features of heart failure. Simplified screening protocols using pocket-sized ECHO machines have been recently evaluated, and training non-physicians in their use holds promise for improved surveillance and implementation of effective secondary prophylaxis 11 12…”

Community study to uncover the full spectrum of rheumatic heart disease in Uganda

“…Second, the prevalence in participants <20 years for borderline and definite RHD was lower than previous reports in this region 6. While possible, we do not believe access to primary healthcare or average socioeconomic status (SES) has substantially modulated RHD risk in this region between 2014 and 2017.…”

“…For practical and logistical reasons, we opted for 16 clusters (4 weeks of sampling 4 days a week, with one cluster screened per day). Using a conservative prevalence estimate of 2.0%, based on prevalence studies in the region,6 we calculated a sample size of 2100 for a two-sided alpha of 0.05 and a precision of ±0.6%. With an average of five eligible family members per household an anticipated response rate of 80%, 480 household would achieve enrolment, with a resulting cluster size of 30 households.…”

Rheumatic heart disease echocardiographic screening: approaching practical and affordable solutions

“…A large school-based study of HAND followed with 1420 children undergoing blinded HAND and STAND studies. In this screening environment, the performance of HAND decreased slightly with 79% sensitivity (98% for definite RHD) and 87% specificity 29. Ten per cent of HAND studies were evaluated for intraobserver and interobserver reliability in this study; self-agreement ranged from 71% to 94% (k=0.70–0.84) and inter-reviewer agreement ranged from 67% to 83% (k=0.34–0.46).…”

“…Image storage and sharing is in a non-digital imaging and communications in medicine (DICOM) format and measurements on the device are cumbersome. Moreover, the colour Doppler settings cannot be adjusted and tend to result in overestimation of the presence and length of valvular regurgitation 29 34…”