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. 2015 May;16(5):475-82.
doi: 10.1093/ehjci/jeu296. Epub 2015 Jan 5.

The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study

Andrea Beaton  1 , Jimmy C Lu  2 , Twalib Aliku  3 , Peter Dean  4 , Lasya Gaur  4 , Jacqueline Weinberg  4 , Justin Godown  5 , Peter Lwabi  6 , Grace Mirembe  7 , Emmy Okello  6 , Allison Reese  4 , Ashley Shrestha-Astudillo  2 , Tyler Bradley-Hewitt  8 , Janet Scheel  4 , Catherine Webb  2 , Robert McCarter  4 , Greg Ensing  2 , Craig Sable  4
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The utility of handheld echocardiography for early rheumatic heart disease diagnosis: a field study

Andrea Beaton et al. Eur Heart J Cardiovasc Imaging. 2015 May.

Abstract

Aims: The World Heart Federation (WHF) guidelines for rheumatic heart disease (RHD) are designed for a standard portable echocardiography (STAND) machine. A recent study in a tertiary care centre demonstrated that they also had good sensitivity and specificity when modified for use with handheld echocardiography (HAND). Our study aimed to evaluate the performance of HAND for early RHD diagnosis in the setting of a large-scale field screening.

Methods and results: STAND was performed in 4773 children in Gulu, Uganda, with 10% randomly assigned to also undergo HAND. Additionally, any child with mitral or aortic regurgitation also underwent HAND. Studies were performed by experienced echocardiographers and blindly reviewed by cardiologists using 2012 WHF criteria, which were modified slightly for HAND--due to the lack of spectral Doppler capability. Paired echocardiograms were performed in 1420 children (mean age 10.8 and 53% female), resulting in 1234 children who were normal, 133 who met criteria for borderline RHD, 47 who met criteria for definite RHD, and 6 who had other diagnoses. HAND had good sensitivity and specificity for RHD detection (78.9 and 87.2%, respectively), but was most sensitive for definite RHD (97.9%). Inter- and intra-reviewer agreement ranged between 66-83 and 71.4-94.1%, respectively.

Conclusions: HAND has good sensitivity and specificity for diagnosis of early RHD, performing best for definite RHD. Protocols for RHD detection utilizing HAND will need to include confirmation by STAND to avoid over-diagnosis. Strategies that evaluate simplified screening protocols and training of non-physicians hold promise for more wide spread deployment of HAND-based protocols.

Keywords: Epidemiology; Handheld echocardiography; Rheumatic heart disease; Screening.

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Figures

Figure 1
Figure 1
Paired STAND/HAND echocardiographic images in patients with RHD. (A and B) Definite RHD. (C and D) Borderline RHD. White arrows point to the dashed white line showing the length of valvular regurgitation.
See this image and copyright information in PMC

Comment in

  • Hand-held ultrasound-the real stethoscope.
    Breithardt OA. Breithardt OA. Eur Heart J Cardiovasc Imaging. 2015 May;16(5):471-2. doi: 10.1093/ehjci/jeu320. Epub 2015 Jan 21. Eur Heart J Cardiovasc Imaging. 2015. PMID: 25609778 No abstract available.

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