Francis, Joshua

Fairhurst H

Yan, Jennifer

Fernandes Monteiro A

Lee A

Maurays J

Kaethner, Alexander

Whalley G

Hardefeldt H

Williamson J

Marangou J

Reeves B

Wheaton G

Robertson T

Horton, Ari

Cush, James

Wade V

Monteiro A

Draper, Anthony

Morris, Peter

Ralph, Anna

Remenyi, Bo

2023-07-01

BACKGROUND: Early detection of rheumatic heart disease (RHD) through echocardiographic screening can facilitate early access to effective treatment, which reduces the risk for progression. Accurate, feasible approaches to echocardiographic screening that can be incorporated into routine health services are needed. The authors hypothesized that offsite expert review could improve the diagnostic accuracy of nonexpert-obtained echocardiographic images. METHODS: This prospective cross-sectional study was performed to evaluate the diagnostic accuracy of health worker-conducted single parasternal long-axis view with a sweep of the heart using hand-carried ultrasound for the detection of RHD in high-risk populations in Timor-Leste and Australia. In the primary analysis, the presence of any mitral or aortic regurgitation met the criteria for a positive screening result. Sensitivity and specificity were calculated for a screen-and-refer approach based on nonexpert practitioner assessment (approach 1) and for an approach using offsite expert review of nonexpert practitioner-obtained images to decide onward referral (approach 2). Each participant had a reference test performed by an expert echocardiographer on the same day as the index test. Diagnosis of RHD was determined by a panel of three experts, using 2012 World Heart Federation criteria. RESULTS: The prevalence of borderline or definite RHD among 3,329 participants was 4.0% (95% CI, 3.4%-4.7%). The sensitivity of approach 1 for borderline or definite RHD was 86.5% (95% CI, 79.5%-91.8%), and the specificity was 61.4% (95% CI, 59.7%-63.1%). Approach 2 achieved similar sensitivity (88.4%; 95% CI, 81.5%-93.3%) and improved specificity (77.1%; 95% CI, 75.6%-78.6%). CONCLUSION: Nonexpert practitioner-obtained single parasternal long-axis view with a sweep of the heart images, reviewed by an offsite expert, can detect borderline and definite RHD on screening with reasonable sensitivity and specificity. Brief training of nonexpert practitioners with ongoing support could be used as an effective strategy for scaling up echocardiographic screening for RHD in high-risk settings.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia. Electronic address: josh.francis@menzies.edu.au.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.

Sunrise Health Service, Barunga, Australia.

Maluk Timor, Dili, Timor-Leste.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; NT Cardiac, Darwin, Australia.

Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.

Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; NT Cardiac, Darwin, Australia; Division of Medicine, Royal Darwin Hospital, Darwin, Australia.

Department of Paediatric Cardiology, Cairns Hospital, Cairns, Australia.

Department of Cardiology, Women's and Children's Hospital, Adelaide, Australia.

Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia; NT Cardiac, Darwin, Australia; Paediatric Cardiology, Monash Heart and Monash Children's Hospital, Melbourne, Australia.

Department of Cardiology, Hospital Nacional Guido Valadares, Dili, Timor-Leste.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Centre for Disease Control, Northern Territory Department of Health, Darwin, Australia; National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Division of Medicine, Royal Darwin Hospital, Darwin, Australia.

Global and Tropical Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Australia; Department of Paediatrics, Royal Darwin Hospital, Darwin, Australia; NT Cardiac, Darwin, Australia.

J Am Soc Echocardiogr. 2023 Jul;36(7):733-745. doi: 10.1016/j.echo.2023.02.007. Epub 2023 Feb 18.

https://pubmed.ncbi.nlm.nih.gov/36806665/?otool=iaurydwlib

https://hdl.handle.net/10137/12499

36

Humans

*Rheumatic Heart Disease/diagnostic imaging/epidemiology

Prospective Studies

Cross-Sectional Studies

Echocardiography/methods

Sensitivity and Specificity

Mass Screening/methods

Prevalence

Abbreviated Echocardiographic Screening for Rheumatic Heart Disease by Nonexperts with and without Offsite Expert Review: A Diagnostic Accuracy Study.

Journal Article

Publication