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Volume 14
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10.3390/diagnostics14040392
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Article

Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD) †

by
Marina G. Diniz
1,2,
Lucas L. Fraga
1,2,
Maria Carmo P. Nunes
1,2,
Kaciane K. B. Oliveira
1,
Ingred Beatriz Amaral
1,
Luz Marina T. Chavez
1,
Luiza Haikal de Paula
1,2,
Beatriz C. Haiashi
1,2,
Alexandre M. Ferreira
1,2,
Mauro Henrique A. Silva
1,2,
Jéssica Elvira M. Veloso
1,
Cássia Aparecida Silva
1,
Fernanda A. Gelape
3,
Luiza P. A. Santos
3,
Arthur M. Amaral
4,
Cecília T. Coelho
1,2,
Lucas C. Diamante
1,2,
Juliane S. Correia
1,2,
Zilda Maria A. Meira
1,
Antonio Luiz P. Ribeiro
1,2,
Alison M. Spaziani
5,
Craig Sable
5 and
Bruno R. Nascimento
1,2,6,* on behalf of the PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática and Other Cardiovascular Diseases) Investigatorsadd Show full author list remove Hide full author list
1
Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
2
Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte 30130-100, MG, Brazil
3
Curso de Medicina, Faculdade de Ciências Médicas de Minas Gerais, Belo Horizonte 30130-110, MG, Brazil
4
Departamento de Medicina, Universidade Federal de Ouro Preto, Ouro Preto 35400-000, MG, Brazil
5
Cardiology, Children’s National Health System, Washington, DC 20010, USA
6
Serviço de Hemodinâmica, Hospital Madre Teresa, Belo Horizonte 30441-070, MG, Brazil
*
Author to whom correspondence should be addressed.
†
The abstract of this work was presented at the Brazilian Society of Cardiology 78th Annual Scientific Session, Porto Alegre, RS, Brazil, 28–30 September 2023 and in the American Heart Association Scientific Sessions, Philadelphia, PA, USA, 11–13 November 2023.
Diagnostics 2024, 14(4), 392; https://doi.org/10.3390/diagnostics14040392
Submission received: 9 January 2024 / Revised: 8 February 2024 / Accepted: 9 February 2024 / Published: 11 February 2024
(This article belongs to the Section Medical Imaging and Theranostics)
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Abstract

Introduction: Handheld echocardiography (echo) is the tool of choice for rheumatic heart disease (RHD) screening. We aimed to assess the agreement between screening and standard echo for latent RHD diagnosis in schoolchildren from an endemic setting. Methods: Over 14 months, 3 nonphysicians used handheld machines and the 2012 WHF Criteria to determine RHD prevalence in consented schoolchildren from Brazilian low-income public schools. Studies were interpreted by telemedicine by 3 experts (Brazil, US). RHD-positive children (borderline/definite) and those with congenital heart disease (CHD) were referred for standard echo, acquired and interpreted by a cardiologist. Agreement between screening and standard echo, by WHF subgroups, was assessed. Results: 1390 students were screened in 6 schools, with 110 (7.9%, 95% CI 6.5–9.5) being screen positive (14 ± 2 years, 72% women). Among 16 cases initially diagnosed as definite RHD, 11 (69%) were confirmed, 4 (25%) reclassified to borderline, and 1 to normal. Among 79 cases flagged as borderline RHD, 19 (24%) were confirmed, 50 (63%) reclassified to normal, 8 (10%) reclassified as definite RHD, and 2 had mild CHD. Considering the 4 diagnostic categories, kappa was 0.18. In patients with borderline RHD reclassified to non-RHD, the most frequent WHF criterion was B (isolated mitral regurgitation, 64%), followed by A (2 mitral valve morphological features, 31%). In 1 patient with definite RHD reclassified to normal, the WHF criterion was D (borderline RHD in aortic and mitral valves). After standard echo, RHD prevalence was 3.2% (95% CI 2.3–4.2). Conclusions: Although practical, RHD screening with handheld devices tends to overestimate prevalence.
Keywords: rheumatic heart disease; screening; echocardiography; accuracy; agreement rheumatic heart disease; screening; echocardiography; accuracy; agreement

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MDPI and ACS Style

Diniz, M.G.; Fraga, L.L.; Nunes, M.C.P.; Oliveira, K.K.B.; Amaral, I.B.; Chavez, L.M.T.; de Paula, L.H.; Haiashi, B.C.; Ferreira, A.M.; Silva, M.H.A.; et al. Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD). Diagnostics 2024, 14, 392. https://doi.org/10.3390/diagnostics14040392

AMA Style

Diniz MG, Fraga LL, Nunes MCP, Oliveira KKB, Amaral IB, Chavez LMT, de Paula LH, Haiashi BC, Ferreira AM, Silva MHA, et al. Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD). Diagnostics. 2024; 14(4):392. https://doi.org/10.3390/diagnostics14040392

Chicago/Turabian Style

Diniz, Marina G., Lucas L. Fraga, Maria Carmo P. Nunes, Kaciane K. B. Oliveira, Ingred Beatriz Amaral, Luz Marina T. Chavez, Luiza Haikal de Paula, Beatriz C. Haiashi, Alexandre M. Ferreira, Mauro Henrique A. Silva, and et al. 2024. "Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD)" Diagnostics 14, no. 4: 392. https://doi.org/10.3390/diagnostics14040392

APA Style

Diniz, M. G., Fraga, L. L., Nunes, M. C. P., Oliveira, K. K. B., Amaral, I. B., Chavez, L. M. T., de Paula, L. H., Haiashi, B. C., Ferreira, A. M., Silva, M. H. A., Veloso, J. E. M., Silva, C. A., Gelape, F. A., Santos, L. P. A., Amaral, A. M., Coelho, C. T., Diamante, L. C., Correia, J. S., Meira, Z. M. A., ... Nascimento, B. R., on behalf of the PROVAR+ (Programa de RastreamentO da VAlvopatia Reumática and Other Cardiovascular Diseases) Investigators. (2024). Agreement between Handheld and Standard Echocardiography for Diagnosis of Latent Rheumatic Heart Disease in Brazilian Schoolchildren from High-Prevalence Settings (Agreement between Screening and Standard Echo for RHD). Diagnostics, 14(4), 392. https://doi.org/10.3390/diagnostics14040392

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