Guidance for echocardiographic diagnosis of rheumatic heart disease issued
MedWire News: The first evidence-based guidelines for the echocardiographic diagnosis of rheumatic heart disease (RHD) have been released.
The new criteria, published in Nature Reviews: Cardiology, have been developed by a group of 21 key researchers in the field of RHD and endorsed by the World Heart Federation (WHF).
"Over the past 5 years, the advent of echocardiographic screening for RHD has revealed a higher RHD burden than previously thought," writes the group, led by Bo Reményi (Menzies School of Health research, Casuarina, Australia).
"In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune."
Currently, individuals already have moderate or severe disease when they are diagnosed with RHD and require surgery, which is largely unaffordable for those who live in middle- and low-income countries where the disease is most prevalent. They also need lifelong injections of penicillin to prevent recurrent infection that worsens the disease.
However, the aim of the new guidelines, say the researchers, is to diagnose individuals when they have mild disease so that they only need to take penicillin for 10 years, or until they reach the age of 21. In these cases, patients often successfully reach the point of no detectable disease.
The WHF echocardiographic guidelines split RHD into three categories on the basis of assessment by two-dimensional, continuous-wave, and color-Doppler echocardiography: definite RHD, borderline RHD, and normal.
For individuals aged 20 years or younger, definite RHD is defined as either pathologic mitral regurgitation (MR) and at least two morphologic features of RHD of the mitral valve (MV), mitral stenosis (MS) mean gradient of at least 4 mmHg, pathologic aortic regurgitation and at least two morphologic features of RHD of the aortic valve (AV), or borderline disease of both the AV and MV.
Borderline RHD is defined as at least two morphologic features of RHD of the MV without pathologic MR or MS, pathologic MR, or pathologic AR.
Normal echocardiographic findings are defined as an MR and AR that does not meet all four Doppler echocardiographic criteria, as well as isolated morphologic features of RHD of the MV and the AV, both without associated pathologic stenosis or regurgitation.
These criteria, along with the guidance for individuals aged over 20, and the criteria for pathologic regurgitation, morphologic features of RHD, and echocardiographic machine settings are also detailed in the paper.
The researchers say that as more experience is gained and research is performed, these guidelines will be revised in future.
They add that in the meantime, they plan to work on a system to ensure that the criteria are made widely available, and support clinicians and public health officials in all regions of the world to apply them accurately.
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By Piriya Mahendra