Simplified echocardiographic screening criteria for rheumatic heart disease

Abstract Introduction Rheumatic Heart Disease (RHD) remains a major health problem in many low and middle-income countries. The paucity of systematic screening studies and differences in the diagnostic criteria might underestimate greatly the reported prevalence rates. The standardized WHF criteria is the gold standard for the echocardiographic diagnosis of RHD. Keeping in mind the setting and the implementation of screening programs which require screening of large groups of individuals with limited resources, we have developed a simplified protocol for the swift recognition of RHD features (Image 1). Purpose Validation of a simplified protocol for the echocardiographic diagnosis of RHD in endemic areas based on screening and follow-up of a large sample of school children in comparison with the WHF criteria. Methods A systematic cross-sectional echocardiographic screening was performed in 3062 randomly selected schoolchildren, aged 5 to 15 years. Follow-up of 72 children with a definite or possible diagnosis of RHD together with a control group of 80 healthy children was carried over 48 to 60 months. The diagnosis of RHD was based on the current WHF criteria and compared to the simplified protocol (Image 2). Results Based on the WHF criteria 60 children were diagnosed with definite RHD (19.6/1000) vs 75 (24.5/1000) and 35 with possible disease (11.4 per 1000) versus 41 (13.4/1000) with the simplified criteria. No significant differences were found in progression or regression rates between both criteria. The appearance of isolated structural changes in 7 controls (8.8%) would lead to borderline diagnosis in the simplified criteria. Conclusion There is no significant difference in progression and regression rates between both criteria. Importantly, the simplified criteria would diagnose 7 children from the control group as possible RHD, which could show the accuracy of the criteria in diagnosing subtle valvular lesions. Funding Acknowledgement Type of funding sources: None. Image 1. Simplified RHD criteriaImage 2. Progress of RHD based on criteria