Key result
Simplified non-expert echo screening detects subclinical RHD with ~100% sensitivity versus expert assessment.
Why the study?
Early detection of subclinical rheumatic heart disease and initiation of secondary prophylaxis prevent progression, but applicability of echocardiographic screening in low-income settings with limited resources is uncertain.
Does echocardiographic screening using simplified criteria applied by non-experts accurately diagnose subclinical rheumatic heart disease compared to expert-performed WHF 2012 criteria in school children?
Cross-Sectional (n=1,618)
Single-blind
No
Does echocardiographic screening using simplified criteria applied by non-experts accurately diagnose subclinical rheumatic heart disease compared to expert-performed WHF 2012 criteria in school children?
Effect estimate: AUC 0.998 (95% CI 0.997-1.000)
p-value: p=<0.001
Simplified echocardiographic criteria applied by briefly trained non-experts using hand-held devices are highly sensitive and specific for diagnosing subclinical rheumatic heart disease in resource-limited settings.
May support non-expert RHD screening in endemic areas; leaves open prospective impact on detection and outcomes.
Background Rheumatic heart disease is among the major causes of morbidity and mortality among children and young adults in low-income countries. Early detection of subclinical rheumatic heart disease and initiation of secondary prophylaxis prevents progression into clinical rheumatic heart disease. In 2012, the World Heart Federation established criteria for the diagnosis of subclinical rheumatic heart disease. However, the applicability and feasibility of screening in low-income settings with insufficient resources has been a setback. Aim of this study was to determine utility of echocardiography for experts compared to non-experts in diagnosing subclinical rheumatic heart disease. Methods A school-based cross-sectional study was conducted among primary and secondary school scholars between the ages of 5 and 20 years in Kondoa District. Eligible primary and secondary school scholars underwent two echocardiographic screening on the basis of simplified echocardiographic criteria by non-expert personnel and then the World Heart Federation criteria of 2012 by expert personnel. Continuous variables presented as the means with standard deviation. Categorical variables are presented as frequencies and percentages. Echocardiographic findings by simplified criteria were compared to the findings of the World Heart Federation 2012. Using cross tabulation in Stata software the utility of the simplified criteria was determined. The two criteria were compared via the area under the receiver operating characteristic curve with a 95% CI. Results Of the 2175 participants sampled, only 1618 underwent echocardiographic screening. The prevalence of subclinical RHD was 14 per 1000. Among the 22 children with subclinical rheumatic heart disease, 14 had definite disease, whereas 8 had borderline rheumatic heart disease. The sensitivity, specificity, positive predictive value and negative predictive value of the simplified criteria for the diagnosis of RHD were 100% (95% CI 100–100%), 99.69% (95% CI 99.41–99.96%), 81.48% (95% CI 79.59–83.37%), and 100% (95% CI 100–100%), respectively. The area under the curve for the simplified criteria for diagnosing subclinical RHD was 0.998 (95% CI 0.997–1.000, p < 0.001). Conclusion In resource-limited endemic areas with limited expert personnel, simplified echocardiographic criteria are useful screening tools for the diagnosis of subclinical Rheumatic Heart Disease consistent with latest World Heart Federation criteria. Clinical trial number Not applicable.
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Macha et al. (2026) conducted a cross-sectional in Subclinical Rheumatic Heart Disease (RHD) (n=1,618). Simplified echocardiographic screening criteria by non-expert personnel vs. World Heart Federation (WHF) 2012 criteria by expert personnel was evaluated on Diagnostic utility (Area under the receiver operating characteristic curve) for subclinical RHD (AUC 0.998, 95% CI 0.997-1.000, p=<0.001). Simplified echocardiographic screening by non-experts demonstrated excellent diagnostic utility for subclinical rheumatic heart disease, yielding an area under the curve of 0.998 and 100% sensitivity compared to expert assessment using WHF 2012 criteria.
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