World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease—an evidence-based guideline

Abstract

Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: ‘definite RHD’, ‘borderline RHD’, and ‘normal’. Four subcategories of ‘definite RHD’ and three subcategories of ‘borderline RHD’ exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control.

Comparison Between Different Strategies of Rheumatic Heart Disease Echocardiographic Screening in Brazil: Data From the PROVAR (Rheumatic Valve Disease Screening Program) Study

“…The method and the implementation of the PROVAR study have been described elsewhere14, 15: the study uses nonexperts for image acquisition, on portable (Vivid Q; GE Healthcare, Milwaukee, WI) and/or handheld (Vscan; GE Healthcare) devices for RHD echocardiographic screening, and telemedicine interpretation by experts in Brazil and the United States, according to the 2012 World Heart Federation9 criteria. The screening team consisted of 2 nurse research coordinators (KO and CG), 1 biomedical technician, and 1 imaging technician (CO); during the preparatory phase, these individuals underwent a combination of completing online RHD educational modules and at least 6 weeks of hands‐on training 20…”

“…World Heart Federation criteria9 were modified for handheld devices, in the absence of spectral Doppler. Cloud computing environments, with online reading for DICOM files and Dropbox with proprietary offline software for Vscan files, were used for remote telemedicine interpretation in Brazil and the United States 21.…”

Thrombocytopenia as a Preoperative Risk Assessment Tool in Patients With Rheumatic Heart Disease Undergoing Valve Replacement Surgery

“…All patients underwent at least 1 VRS and underwent coronary artery bypass grafting when they had significant concomitant coronary artery disease, according to recommendations 11. RHD was diagnosed on the basis of having a history of acute rheumatic fever and/or symptoms of precordial abnormalities, the presence of a heart murmur, or valve abnormalities on echocardiographic scans 12. All of the patients underwent preoperative coronary angiography.…”

Clinical Impact and Costs of Echocardiographic Screening for Rheumatic Heart Disease

“…Both models assumed that a sonographer performed the screening with a portable machine in the community, detecting findings consistent with World Heart Federation criteria for Definite RHD 17. Positive scans would be reviewed by a pediatric cardiologist, who would then determine appropriate follow‐up.…”