World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease--an evidence-based guideline - PubMed Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2012 Feb 28;9(5):297-309.
doi: 10.1038/nrcardio.2012.7.

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

Bo Reményi  1 , Nigel Wilson, Andrew Steer, Beatriz Ferreira, Joseph Kado, Krishna Kumar, John Lawrenson, Graeme Maguire, Eloi Marijon, Mariana Mirabel, Ana Olga Mocumbi, Cleonice Mota, John Paar, Anita Saxena, Janet Scheel, John Stirling, Satupaitea Viali, Vijayalakshmi I Balekundri, Gavin Wheaton, Liesl Zühlke, Jonathan Carapetis
Affiliations
Review

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

Bo Reményi et al. Nat Rev Cardiol. .

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Schematic images of the MV in systole. a | A normal MV. b | RHD with excessive leaflet tip motion, which results in abnormal coaptation and regurgitation, but usually does not meet the echocardiographic definition of ‘MV prolapse’. c | Echocardiographic MV prolapse, defined by >2 mm billowing of the leaflet tissue into the left atrium. In echocardiographic MV prolapse (c), coaptation of leaflets often remains normal, as the free edges of the leaflet stay in apposition below the plane of the MV annulus. Abbreviation: AMVL, anterior MV leaflet; MV, mitral valve; PMVL, posterior MV leaflet; RHD, rheumatic heart disease.
Figure 2
Figure 2
Schematic images of the MV in diastole. a | A normal MV. b | A rheumatic MV with thickened and restricted anterior and posterior leaflets. Abbreviations: AMVL, anterior MV leaflet; MV, mitral valve; PMVL, posterior MV leaflet.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Carapetis JR, Steer AC, Mulholland EK, Weber M. The global burden of group A streptococcal diseases. Lancet Infect Dis. 2005;5:685–694. - PubMed
    1. Special Writing Group of the Committee on Rheumatic Fever and Kawasaki Disease of the Council on Cardiovascular Disease in the Young of the American Heart Association. Guidelines for the diagnosis of rheumatic fever. Jones Criteria, 1992 update. JAMA. 1992;268:2069–2073. - PubMed
    1. World Health Organisation. Rheumatic Fever and Rheumatic Heart Disease: Report of a WHO Expert Consultation, Geneva, 29 October–1 November 2001. WHO [online] 2010 www.who.int/entity/cardiovascular_diseases/resources/trs923/en/
    1. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand. Diagnosis and management of acute rheumatic fever and rheumatic heart disease in Australia —an evidence-based review. Heart Foundation [online] 2006 http://www.heartfoundation.org.au/Information-For-Professionals/Clinical....
    1. Heart Foundation of New Zealand and Cardiac Society of Australia and New Zealand. New Zealand guidelines for rheumatic fever 1: diagnosis, management and secondary prevention. Heart Foundation [online] 2006 http://www.heartfoundation.org.nz/uploads/Rheumatic%20fever%20guideline%....

Publication types

MeSH terms