Reddy Ashwin, Jatana S K, Nair Mng
Ex-Medical Cadet, Department of Paediatrics, Armed Forces Medical College, Pune-411 040.
Associate Professor, Department of Paediatrics, Armed Forces Medical College, Pune-411 040.
Med J Armed Forces India. 2004 Jul;60(3):255-8. doi: 10.1016/S0377-1237(04)80058-3. Epub 2011 Jul 21.
Rheumatic heart disease (RHD) is still a common form of heart disease among children and young adults, especially in developing countries like India. Between 1940 and 1983, the prevalence rate of RHD varied from 1.8 to 11 per 1000 (national average 6 per 1000), while between 1984 and 1995 the rate varied from 1 to 5.4 per 1000 [1]. The study was carried out to assess the accuracy of a medical student's clinical evaluation of valvular heart disease and compare it with that of an echocardiographic evaluation and to determine the sensitivity, specificity and predictive values of clinical examination as compared to echocardiography for the various lesions in RHD patients.
50 children between the ages of 5-16 years, attending the out patient department or admitted in a large teaching hospital, satisfying the criteria of RHD, were included in the study. Each patient underwent detailed clinical evaluation and relevant investigations including echocardiography.
Mitral valve was involved most often both by echocardiography and clinically. Isolated aortic valve involvement was rare. The most common lesion was mitral regurgitation (MR) both by auscultation and by echo. Mixed lesions were seen more often than pure lesions. Mitral stenosis (MS) had the highest sensitivity while tricuspid regurgitation (TR) had the highest specificity. MR had the highest positive predictive value and MS the highest negative predictive value. Sensitivity and specificity of aortic regurgitation (AR) was very low when compared to earlier studies. There was a statistically significant difference between echo diagnosis and clinical diagnosis (p < 0.05).
It is recommended that echocardiography be done routinely for the diagnosis of cardiac lesions in patients of RHD as clinical examination alone can miss various lesions, especially when the lesions are mild or when multiple lesions are present.
风湿性心脏病（RHD）在儿童和年轻人中仍然是一种常见的心脏病形式，尤其是在印度等发展中国家。1940年至1983年间，RHD的患病率为每1000人中有1.8至11例（全国平均每1000人中有6例），而1984年至1995年间，该患病率为每1000人中有1至5.4例[1]。本研究旨在评估医学生对瓣膜性心脏病临床评估的准确性，并将其与超声心动图评估进行比较，同时确定与超声心动图相比，临床检查对RHD患者各种病变的敏感性、特异性和预测价值。
本研究纳入了50名年龄在5至16岁之间、符合RHD标准、在大型教学医院门诊就诊或住院的儿童。每位患者均接受了详细的临床评估和包括超声心动图在内的相关检查。
超声心动图和临床检查均显示二尖瓣受累最为常见。单纯主动脉瓣受累罕见。听诊和超声检查发现最常见的病变均为二尖瓣反流（MR）。混合性病变比单纯性病变更常见。二尖瓣狭窄（MS）的敏感性最高，而三尖瓣反流（TR）的特异性最高。MR的阳性预测价值最高，MS的阴性预测价值最高。与早期研究相比，主动脉反流（AR）的敏感性和特异性非常低。超声诊断与临床诊断之间存在统计学显著差异（p < 0.05）。
建议对RHD患者常规进行超声心动图检查以诊断心脏病变，因为仅靠临床检查可能会遗漏各种病变，尤其是当病变较轻或存在多种病变时。
