Nascimento Bruno R, Nunes Maria Carmo P, Lopes Eduardo L V, Rezende Vitória M L R, Landay Taylor, Ribeiro Antonio L P, Sable Craig, Beaton Andrea Z
Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Serviço de Hemodinâmica, Hospital das Clínicas, Belo Horizonte, Brazil Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Division of Cardiology and Cardiovascular Surgery, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil Departamento de Clínica Médica, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Heart. 2016 May;102(9):658-64. doi: 10.1136/heartjnl-2015-308635. Epub 2016 Feb 18.
Rheumatic heart disease (RHD) affects at least 32.9 million people worldwide and ranks as a leading cause of death and disability in low-income and middle-income countries (LMICs). Echocardiographic screening has been demonstrated to be a powerful tool for early RHD detection, and holds potential for global RHD control. However, national screening programmes have not emerged. Major barriers to implementation include the lack of human and financial resources in LMICs. Here, we focus on recent research advances that could make echocardiographic screening more practical and affordable, including handheld echocardiography devices, simplified screening protocols and task shifting of echocardiographic screening to non-experts. Additionally, we highlight some important remaining questions before echocardiographic screening can be widely recommended, including demonstration of cost-effectiveness, assessment of the impact of screening on children and communities, and determining the importance of latent RHD. While a single strategy for echocardiographic screening in all high-prevalence areas is unlikely, we believe recent advancements are bringing the public health community closer to developing sustainable programmes for echocardiographic screening.
风湿性心脏病（RHD）在全球至少影响3290万人，在低收入和中等收入国家（LMICs）中是导致死亡和残疾的主要原因之一。超声心动图筛查已被证明是早期检测RHD的有力工具，并且在全球RHD控制方面具有潜力。然而，国家筛查计划尚未出现。实施的主要障碍包括LMICs缺乏人力和财力资源。在此，我们关注近期的研究进展，这些进展可使超声心动图筛查更具实用性和可承受性，包括手持式超声心动图设备、简化的筛查方案以及将超声心动图筛查任务转移给非专家。此外，我们强调在广泛推荐超声心动图筛查之前一些重要的遗留问题，包括成本效益的证明、筛查对儿童和社区影响的评估以及确定潜伏性RHD的重要性。虽然在所有高流行地区采用单一的超声心动图筛查策略不太可能，但我们相信近期的进展正使公共卫生界更接近制定可持续的超声心动图筛查计划。
