Webb Rachel H, Wilson Nigel J, Lennon Diana R, Wilson Elizabeth M, Nicholson Ross W, Gentles Tom L, O'Donnell Clare P, Stirling John W, Zeng Irene, Trenholme Adrian A
Green Lane Paediatric and Congenital Cardiology Department, Starship Children's Hospital, Auckland, New Zealand.
Cardiol Young. 2011 Aug;21(4):436-43. doi: 10.1017/S1047951111000266. Epub 2011 Mar 31.
Echocardiography detects a greater prevalence of rheumatic heart disease than heart auscultation. Echocardiographic screening for rheumatic heart disease combined with secondary prophylaxis may potentially prevent severe rheumatic heart disease in high-risk populations. We aimed to determine the prevalence of rheumatic heart disease in children from an urban New Zealand population at high risk for acute rheumatic fever.
To optimise accurate diagnosis of rheumatic heart disease, we utilised a two-step model. Portable echocardiography was conducted on 1142 predominantly Māori and Pacific children aged 10-13 years. Children with an abnormal screening echocardiogram underwent clinical assessment by a paediatric cardiologist together with hospital-based echocardiography. Rheumatic heart disease was then classified as definite, probable, or possible. Portable echocardiography identified changes suggestive of rheumatic heart disease in 95 (8.3%) of 1142 children, which reduced to 59 (5.2%) after cardiology assessment. The prevalence of definite and probable rheumatic heart disease was 26.0 of 1000, with 95% confidence intervals ranging from 12.6 to 39.4. Portable echocardiography overdiagnosed rheumatic heart disease with physiological valve regurgitation diagnosed in 28 children. A total of 30 children (2.6%) had non-rheumatic cardiac abnormalities, 11 of whom had minor congenital mitral valve anomalies.
We found high rates of undetected rheumatic heart disease in this high-risk population. Rheumatic heart disease screening has resource implications with cardiology evaluation required for accurate diagnosis. Echocardiographic screening for rheumatic heart disease may overdiagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.
超声心动图检测出的风湿性心脏病患病率高于心脏听诊。对风湿性心脏病进行超声心动图筛查并结合二级预防，可能会预防高危人群中严重风湿性心脏病的发生。我们旨在确定新西兰城市中急性风湿热高危儿童人群中风湿性心脏病的患病率。
为优化风湿性心脏病的准确诊断，我们采用了两步模型。对1142名年龄在10 - 13岁、主要为毛利人和太平洋岛民的儿童进行了便携式超声心动图检查。超声心动图筛查异常的儿童由儿科心脏病专家进行临床评估，并接受基于医院的超声心动图检查。然后将风湿性心脏病分为确诊、可能或疑似。便携式超声心动图在1142名儿童中的95名（8.3%）发现了提示风湿性心脏病的变化，经心脏病学评估后降至59名（5.2%）。确诊和可能的风湿性心脏病患病率为每1000人中有26.0例，95%置信区间为12.6至39.4。便携式超声心动图对风湿性心脏病存在过度诊断，28名儿童被诊断为生理性瓣膜反流。共有30名儿童（2.6%）患有非风湿性心脏异常，其中11名患有轻度先天性二尖瓣异常。
我们发现该高危人群中未被检测出的风湿性心脏病发病率很高。风湿性心脏病筛查对资源有影响，准确诊断需要心脏病学评估。除非排除先天性二尖瓣异常和生理性反流，否则对风湿性心脏病进行超声心动图筛查可能会过度诊断风湿性心脏病。
