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Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD)

Authors :
Marina G. Diniz
Lucas L. Fraga
Maria Carmo P. Nunes
Kaciane K. B. Oliveira
Ingred Beatriz Amaral
Luz Marina T. Chavez
Luiza Haikal de Paula
Beatriz C. Haiashi
Alexandre M. Ferreira
Mauro Henrique A. Silva
Jéssica Elvira M. Veloso
Cássia Aparecida Silva
Fernanda A. Gelape
Luiza P. A. Santos
Arthur M. Amaral
Cecília T. Coelho
Lucas C. Diamante
Juliane S. Correia
Zilda Maria A. Meira
Antonio Luiz P. Ribeiro
Alison M. Spaziani
Craig Sable
Bruno R. Nascimento
Source :
Diagnostics, Vol 14, Iss 4, p 392 (2024)
Publication Year :
2024
Publisher :
MDPI AG, 2024.

Abstract

Introduction: Handheld echocardiography (echo) is the tool of choice for rheumatic heart disease (RHD) screening. We aimed to assess the agreement between screening and standard echo for latent RHD diagnosis in schoolchildren from an endemic setting. Methods: Over 14 months, 3 nonphysicians used handheld machines and the 2012 WHF Criteria to determine RHD prevalence in consented schoolchildren from Brazilian low-income public schools. Studies were interpreted by telemedicine by 3 experts (Brazil, US). RHD-positive children (borderline/definite) and those with congenital heart disease (CHD) were referred for standard echo, acquired and interpreted by a cardiologist. Agreement between screening and standard echo, by WHF subgroups, was assessed. Results: 1390 students were screened in 6 schools, with 110 (7.9%, 95% CI 6.5–9.5) being screen positive (14 ± 2 years, 72% women). Among 16 cases initially diagnosed as definite RHD, 11 (69%) were confirmed, 4 (25%) reclassified to borderline, and 1 to normal. Among 79 cases flagged as borderline RHD, 19 (24%) were confirmed, 50 (63%) reclassified to normal, 8 (10%) reclassified as definite RHD, and 2 had mild CHD. Considering the 4 diagnostic categories, kappa was 0.18. In patients with borderline RHD reclassified to non-RHD, the most frequent WHF criterion was B (isolated mitral regurgitation, 64%), followed by A (2 mitral valve morphological features, 31%). In 1 patient with definite RHD reclassified to normal, the WHF criterion was D (borderline RHD in aortic and mitral valves). After standard echo, RHD prevalence was 3.2% (95% CI 2.3–4.2). Conclusions: Although practical, RHD screening with handheld devices tends to overestimate prevalence.

Details

Language :
English
ISSN :
20754418
Volume :
14
Issue :
4
Database :
Directory of Open Access Journals
Journal :
Diagnostics
Publication Type :
Academic Journal
Accession number :
edsdoj.7a7ed19f4d6c459b8ed408dbc0b9964a
Document Type :
article
Full Text :
https://doi.org/10.3390/diagnostics14040392