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27-05-2012 | Cardiology | Article

Echo improves rheumatic heart disease detection in Africa


Free abstract

MedWire News: Researchers report that adding echocardiography to standard rheumatic heart disease (RHD)-screening protocols may increase the frequency with which the condition is detected in endemic regions of the world, such as sub-Saharan Africa.

By performing "one of the largest single-population childhood RHD prevalence studies to date, we confirm a much higher rate of possible, probable, and definite RHD identified by echocardiography than by clinical examination alone," they say.

Andrea Beaton, from the Children's National Medical Center in Washington DC, USA, and co-investigators also suggest that in endemic regions, low socioeconomic populations may reap the most benefit from the implementation of RHD-screening programs.

As reported in Circulation, Beaton and colleagues assigned 4869 Ugandan school children aged 5‑16 years to screening with auscultation plus echocardiography. The screening results were then used to classify each child's RHD disease likelihood as possible, probable, or definite - as recommended by World Health Organization and National Institutes of Health 2006 guidelines.

In all, 130 children (2.7%) had abnormalities detected by echocardiography. Of these, 55.4% (n=72) had possible, probable, or definite RHD, 13.8% (n=18) had congenital heart disease, and 30.8% (n=40) had no disease.

A total of 23 RHD cases were detected by auscultation, whereas echocardiography detected 72 cases - a threefold higher detection rate than auscultation.

RHD was found to be commonest among low socioeconomic groups and children aged 10 years or older.

Editorialists Karen Sliwa and Peter Zilla (University of Cape Town, South Africa) said that the findings of Beaton and colleagues are important, but their focus on school-aged participants "address[es] only the tip of the iceberg, in view of the disease progression in the undiagnosed post school-age population groups."

Sliwa and Zilla conclude that research into the "impact of RHD on population health, productivity, and premature mortality" will be required if RHD rates are to be minimized worldwide.

By Lauretta Ihonor

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