The utility of highly abbreviated echocardiographic protocol for detection of rheumatic heart disease a prospective population based study in timor leste.

Introduction: Anecdotal evidence suggests a significant burden of Rheumatic Heart Disease (RHD) in Timor-Leste. We conducted the first echocardiography-based screening study to determine the prevalence of RHD in school-aged Timorese children. Additionally, we prospectively tested the utility of an abbreviated echocardiographic screening protocol limited to the parasternallong- axis-view. Method(s): Students were enrolled from schools in urban and rural districts in Timor-Leste, using opt-out consent that was approved by ethics committees. All students underwent a full screening echocardiogram performed on a Vivid I or Q machine by cardiologists. Following the first parasternal-long-axis-view with 2-D and colour-Doppler, cardiologists were required to log any abnormalities detected prior to proceeding to a full screening study. Those with abnormal screening studies immediately underwent a full congenital echocardiogram. RHD was classified as borderline or definite as per World Heart Federation criteria. The prevalence of RHD and the sensitivity and specificity of the abbreviated protocol was calculated. Result(s): Total of 1413 children were screened; 739 (52%) female and the median age was 12 years (range 4-24). The point prevalence of definite RHD was 1.8% and borderline 1.6% (total 3.4%). An abnormal parasternal-long-axis-view was documented in 113/1413 (8.0%). No cases of RHD were missed. The sensitivity and the specificity of the abbreviated protocol in detecting RHD was 1.0 and 0.95 (CI 95% 0.94-0.96) respectively. Congenital heart disease was identified in 20 children (1.4%) with 2 needing cardiac surgery. Of these 14 had abnormalities on parasternal-long-axis-view. Only insignificant congenital cardiac defects were missed. All children were linked to care. Conclusion(s): This prospective study showed that an abbreviated screening protocol, in school-aged children, limited to a single parasternal-long-axis-view had very high sensitivity and specificity to dete