Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren
Evaluation of a screening protocol using auscultation and portable echocardiography to detect asymptomatic rheumatic heart disease in Tongan schoolchildren
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DOI：
10.1038/ncpcardio1185
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发表时间：
2008-07-01
期刊：
影响因子：
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通讯作者：
Steer, Andrew C.
中科院分区：
文献类型：
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作者：
Carapetis, Jonathan R.;Hardy, Myra;Steer, Andrew C.
风湿性心脏病（RHD）是发展中国家的一个重要问题；然而，许多病例只有在疾病进展为心力衰竭时才被发现。筛查可以早期发现病例，但没有筛查指南。方法：我们在汤加对5053名小学生进行了横断面筛查研究，其中听诊和心脏杂音的超声心动图用于识别RHD。我们还分析了由医学生进行的三阶段听诊来检测任何心脏杂音，由当地儿科医生进行的第二阶段听诊来区分病理性和无害的杂音，以及对病理性杂音进行超声心动图检查是否会改变结果。结果明确RHD患病率为33.2 / 1000。RHD的患病率随着年龄的增长而显著增加，在10-12岁的儿童中达到42.6 / 1000的峰值。大多数瓣膜病变（169例中91例[54%]）是轻微的。听诊发现病理性杂音的敏感性较低（46.4%），听诊发现任何杂音不影响超声心动图发现病理的可能性。病理性杂音的发现确实显著增加了超声心动图发现病理的可能性，但仍有54%的超声心动图发现病理（主要是RHD）。结论筛查是检测无症状RHD高患病率地区的有效方法，我们报告了超声心动图证实的高患病率。然而，最合适的筛查策略仍有待确认，实施将取决于超声心动图的可用性和训练有素的工作人员。
Background Rheumatic heart disease (RHD) is an important problem in developing countries; however, many cases are detected only when the disease has progressed to cardiac failure. Screening can detect cases earlier, but there are no screening guidelines.Methods We performed a cross-sectional screening study in Tonga among 5,053 primary school children, in whom auscultation followed by echocardiography of those with heart murmurs were used to identify RHD. We also analyzed whether a three-stage screening protocol of auscultation performed by a medical student to detect any heart murmur, second-stage auscultation performed by a local pediatrician to differentiate pathological from innocent murmurs and echocardiography of those with pathological murmurs altered outcomes.Results The prevalence of definite RHD was 33.2 per 1,000. The prevalence of RHD increased significantly with age, peaking at 42.6 per 1,000 in children aged 10-12 years. Most valve lesions (91 [54%] of 169) were mild. Auscultation to detect pathological murmurs was poorly sensitive (46.4%), and the finding of any murmur on auscultation did not affect the likelihood of detecting pathology on echocardiography. The finding of a pathological murmur did significantly increase the likelihood of detecting pathology on echocardiography, but still missed 54% of those with pathology (mainly RHD) detected on echocardiography.Conclusions Screening is a useful method for detecting asymptomatic RHD in regions of high prevalence and we report a high echocardiographically confirmed prevalence. The most appropriate screening strategy remains to be confirmed, however, and implementation will depend on the availability of echocardiography and trained staff.