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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Rheumatic heart disease screening by echocardiography: The inadequacy of world health organization criteria for optimizing the diagnosis of subclinical disease
Circulation, Volume 120, No. 8, Year 2009
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Description
BackgroundEarly case detection is vital in rheumatic heart disease (RHD) in children to minimize the risk of advanced valvular heart disease by preventive measures. The currently utilized World Health Organization (WHO) criteria for echocardio graphic diagnosis of subclinical RHD emphasize the presence of pathological valve regurgitation but do not include valves with morphological features of RHD without pathological regurgitation. We hypothesized that adding morphological features to diagnostic criteria might have significant consequences in terms of case detection rates. Methods and ResultsWe screened 2170 randomly selected school children aged 6 to 17 years in Maputo, Mozambique, clinically and by a portable ultrasound system. Two different echocardiographic sets of criteria for RHD were assessed: WHO (exclusively Doppler-based) and combined (Doppler and morphology-based) criteria. Independent investigators reviewed all suspected RHD cases using a higher-resolution, nonportable ultrasound system. On-site echocardiography identified 18 and 124 children with suspected RHD according to WHO and combined criteria, respectively. After consensus review, 17 were finally considered to have definite RHD according to WHO criteria, and 66 had definite RHD according to combined criteria, giving prevalence rates of 7.8 (95% confidence interval, 4.6 to 12.5) and 30.4 (95% confidence interval, 23.6 to 38.5) per 1000 children, respectively (P < 0.0001, exact McNemar test). ConclusionsImportant consideration should be given to echocardiographic criteria for detecting subclinical RHD because the number of cases detected may differ importantly according to the diagnostic criteria utilized. Currently recommended WHO criteria risk missing up to three quarters of cases of subclinically affected and therefore potentiallytreatable children with RHD. © 2009 American Heart Association, Inc.
Authors & Co-Authors
Marijon, Éloi
France, Paris
Hôpital Européen Georges-pompidou
Celermajer, David S.
Australia, Sydney
The University of Sydney
Tafflet, Muriel
France, Paris
Hôpital Européen Georges-pompidou
El-Haou, Saïd
France, Paris
Unité de Recherche Sur Les Maladies Cardiovasculaires, le Métabolisme et la Nutrition
Jani, Dinesh N.
Mozambique, Maputo
Instituto do Coracao Maputo
Ferreira, Beatriz
Mozambique, Maputo
Instituto do Coracao Maputo
Mocumbi, Ana Olga H.
Mozambique, Maputo
Instituto do Coracao Maputo
Paquet, Christophe
France, Saint-maurice
Institut de Veille Sanitaire
Sidi, Daniel
Mozambique, Maputo
Instituto do Coracao Maputo
France, Paris
Université Paris Cité
Jouven, Xavier P.
France, Paris
Hôpital Européen Georges-pompidou
Statistics
Citations: 157
Authors: 10
Affiliations: 6
Identifiers
Doi:
10.1161/CIRCULATIONAHA.109.849190
ISSN:
00097322
e-ISSN:
15244539
Research Areas
Maternal And Child Health
Noncommunicable Diseases
Study Design
Cross Sectional Study
Study Locations
Mozambique