Screening for Rheumatic Heart Disease Evaluation of a Focused Cardiac Ultrasound Approach
Screening for Rheumatic Heart Disease Evaluation of a Focused Cardiac Ultrasound Approach
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DOI：
10.1161/circimaging.114.002324
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发表时间：
2015-01-01
影响因子：
7.5
通讯作者：
Marijon, Eloi
中科院分区：
文献类型：
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作者：
Mirabel, Mariana;Bacquelin, Raoul;Marijon, Eloi
背景-风湿性心脏病（RHD）仍然是世界范围内的一个主要公共卫生问题。虽然早期诊断超声心动图可能发挥重要作用，在发展积极的监督，系统的评价资源贫乏的设置简单的方法是need.Methods和Results-We前瞻性地比较了聚焦心脏超声（FCU）的参考方法RHD筛查学龄儿童人群。FCU包括（1）使用袖珍超声心动图机，（2）非专业人员（2名受过专门培训的护士），（3）一套简化的超声心动图标准。参考方法使用标准化超声心动图检查，由心脏病专家根据2012年世界心脏联合会标准进行审查。在6种不同的超声心动图标准中，首先在初步阶段进行测试，二尖瓣返流射流长度>= 2 cm或任何主动脉瓣返流被认为最适合作为FCU标准。在入组的1217名受试者中（平均年龄，9.6 ± 1岁; 49.6%男性），49名（4%）通过参考方法诊断出患有RHD。FCU检测RHD的灵敏度为83.7%（95%置信区间，73.3-94.0），护士A和77.6%（95%置信区间，65.9-89.2），护士B。根据用户的说法，FCU的特异性为90.9%（95%置信区间，89.3-92.6）和92.0%（95%置信区间，90.4-93.5）。护士之间的协议的百分比为91.4%. Conclusion-FCU的非专家使用袖珍设备似乎是可行的，并产生可接受的灵敏度和特异性RHD检测相比，国家的最先进的方法，从而打开了新的视角，在低资源的设置为RHD的大规模筛查。
Background-Rheumatic heart disease (RHD) remains a major public health problem worldwide. Although early diagnosis by echocardiography may potentially play a key role in developing active surveillance, systematic evaluation of simple approaches in resource poor settings are needed.Methods and Results-We prospectively compared focused cardiac ultrasound (FCU) to a reference approach for RHD screening in a school children population. FCU included (1) the use of a pocket-sized echocardiography machine, (2) nonexpert staff (2 nurses with specific training), and (3) a simplified set of echocardiographic criteria. The reference approach used standardized echocardiographic examination, reviewed by an expert cardiologist, according to 2012 World Heart Federation criteria. Among the 6 different echocardiographic criteria, first tested in a preliminary phase, mitral regurgitation jet length >= 2 cm or any aortic regurgitation was considered best suited to be FCU criteria. Of the 1217 subjects enrolled (mean, 9.6 +/- 1 years; 49.6% male), 49 (4%) were diagnosed with RHD by the reference approach. The sensitivity of FCU for the detection of RHD was 83.7% (95% confidence interval, 73.3-94.0) for nurse A and 77.6% (95% confidence interval, 65.9-89.2) for nurse B. FCU yielded a specificity of 90.9% (95% confidence interval, 89.3-92.6) and 92.0% (95% confidence interval, 90.4-93.5) according to users. Percentage of agreement among nurses was 91.4%.Conclusions-FCU by nonexperts using pocket devices seems feasible and yields acceptable sensitivity and specificity for RHD detection when compared with the state-of-the-art approach, thereby opening new perspectives for mass screening for RHD in low-resource settings.