Now showing 1 - 3 of 3
  • Publication
    Journal Article
    Echocardiographic Screening for Rheumatic Heart Disease: A Brief History and Implications for the Future.
    (2024-04-24T14:00:00Z) ; ; ; ;
    Whalley, Gillian
    Transthoracic echocardiography is the gold standard for early detection of rheumatic heart disease (RHD) in asymptomatic children living in high-risk regions. Advances in technology allowing miniaturisation and increased portability of echocardiography devices have improved the accessibility of this vital diagnostic tool in RHD-endemic locations. Automation of image optimisation techniques and simplified RHD screening protocols permit use by non-experts after a brief period of training. While these changes are welcome advances in the battle to manage RHD, it is important that the sensitivity and specificity of RHD detection be maintained by all echocardiography users on any device to ensure accurate and timely diagnosis of RHD to facilitate initiation of appropriate therapy. This review of the evolution of echocardiography and its use in the detection of rheumatic valve disease may serve as a reminder of the key strengths and potential pitfalls of this increasingly relied-upon diagnostic test.
  • Publication
    Journal Article
    2023 World Heart Federation guidelines for the echocardiographic diagnosis of rheumatic heart disease.
    (2023-11-02)
    Rwebembera, Joselyn
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    Marangou, James
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    Mwita, Julius Chacha
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    Mocumbi, Ana Olga
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    Mota, Cleonice
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    Okello, Emmy
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    Nascimento, Bruno
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    Thorup, Lene
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    Beaton, Andrea
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    Kado, Joseph
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    Kumar, Raman Krishna
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    Lawrenson, John
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    Marijon, Eloi
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    Mirabel, Mariana
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    Nunes, Maria Carmo Pereira
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    Piñeiro, Daniel
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    Pinto, Fausto
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    Ralston, Kate
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    Sable, Craig
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    Sanyahumbi, Amy
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    Saxena, Anita
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    Sliwa, Karen
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    Steer, Andrew
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    Viali, Satupaitea
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    Wheaton, Gavin
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    Wilson, Nigel
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    Zühlke, Liesl
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    Rheumatic heart disease (RHD) is an important and preventable cause of morbidity and mortality among children and young adults in low-income and middle-income countries, as well as among certain at-risk populations living in high-income countries. The 2012 World Heart Federation echocardiographic criteria provided a standardized approach for the identification of RHD and facilitated an improvement in early case detection. The 2012 criteria were used to define disease burden in numerous epidemiological studies, but researchers and clinicians have since highlighted limitations that have prompted a revision. In this updated version of the guidelines, we incorporate evidence from a scoping review, an expert panel and end-user feedback and present an approach for active case finding for RHD, including the use of screening and confirmatory criteria. These guidelines also introduce a new stage-based classification for RHD to identify the risk of disease progression. They describe the latest evidence and recommendations on population-based echocardiographic active case finding and risk stratification. Secondary antibiotic prophylaxis, echocardiography equipment and task sharing for RHD active case finding are also discussed. These World Heart Federation 2023 guidelines provide a concise and updated resource for clinical and research applications in RHD-endemic regions.
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  • Publication
    Journal Article
    The Echocardiographic Diagnosis of Rheumatic Heart Disease: A Review of the Performance of the World Heart Federation Criteria 2012-2023.
    (2024-05-13)
    Marangou, James
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    Rwebembera, Joselyn
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    Mwita, Julius
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    Thorup, Lene
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    Nascimento, Bruno Ramos
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    Beaton, Andrea
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    Kumar, Krishna
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    Okello, Emmy
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    Raltson, Kate
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    Sable, Craig
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    Wheaton, Gavin
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    Wilson, Nigel
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    Zuhlke, Liesl
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    Mota, Cleonice
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    Mocumbi, Ana
    The World Heart Federation (WHF) published the first evidence-based guidelines on the echocardiographic diagnosis of rheumatic heart disease (RHD) in 2012. These guidelines have since been applied internationally in research and clinical practice. Substantial research has assessed the utility of the 2012 WHF criteria, including its applicability in low-resource settings. This article summarises the evidence regarding the performance of the guidelines.A scoping review assessing the performance of the guidelines was performed. Cochrane, Embase, Medline, PubMed Lilacs, Sielo, and Portal BVS databases were searched for studies on the performance of the guidelines between January 2012-March 2023, and 4047 manuscripts met the search criteria, of which 34 were included. This included papers assessing the specificity, inter-rater reliability, application using hand-carried ultrasound, and modification of the criteria for simplicity. The review followed the PRISMA Extension for Scoping Reviews guideline.The WHF 2012 criteria were 100% specific for definite RHD when applied in low-prevalence populations. The criteria demonstrated substantial and moderate inter-rater reliability for detecting definite and borderline RHD, respectively. The inter-rater reliability for morphological features was lower than for valvular regurgitation. When applied to hand-carried ultrasound performed by an expert, modified versions of the criteria demonstrated a sensitivity and specificity range of 79-90% and 87-93% respectively for detecting any RHD, performing best for definite RHD. The sensitivity and the specificity were reduced when performed in task-sharing but remains moderately accurate.The WHF 2012 criteria provide clear guidance for the echocardiographic diagnosis of RHD that is reproducible and applicable to a range of echocardiographic technology. Furthermore, the criteria are highly specific and particularly accurate for detecting definite RHD. There are limitations in applying all aspects of the criteria in specific settings, including task-sharing. This summary of evidence can inform the updated version of the WHF guidelines to ensure improved applicability in all RHD endemic regions.