Allen Marvin, Allen John, Naseri Take, Gardner Rebecca, Tolley Dennis, Allen Lori
1Brigham Young University,Provo,Utah,United States of America.
2Samoan Ministries of Health,Apia,Samoa.
Cardiol Young. 2017 Oct;27(8):1599-1605. doi: 10.1017/S1047951117000907.
Echocardiography has been proposed as a method to screen children for rheumatic heart disease. The World Heart Federation has established guidelines for echocardiographic screening. In this study, we describe a rapid echocardiogram screening protocol according to the World Heart Federation guidelines in Samoa, endemic for rheumatic heart disease.
We performed echocardiogram screening in schoolchildren in Samoa between 2013 and 2015. A brief screening echocardiogram was performed on all students. Children with predefined criteria suspicious for rheumatic hear diseases were referred for a more comprehensive echocardiogram. Complete echocardiograms were classified according to the World Heart Federation guidelines and severity of valve disease.
Echocardiographic screening was performed on 11,434 children, with a mean age of 10.2 years; 51% of them were females. A total of 558 (4.8%) children underwent comprehensive echocardiography, including 49 students who were randomly selected as controls. Definite rheumatic heart disease was observed in 115 students (10.0 per 1000): 92 students were classified as borderline (8.0 per 1000) and 23 with CHD. Advanced disease was identified in 50 students (4.4 per 1000): 15 with severe mitral regurgitation, five with severe aortic regurgitation, 11 with mitral stenoses, and 19 with mitral and aortic valve disease.
We successfully applied a rapid echocardiographic screening protocol to a large number of students over a short time period - 28 days of screening over a 3-year time period - to identify a high prevalence of rheumatic heart disease. We also reported a significantly higher rate of advanced disease compared with previously published echocardiographic screening programmes.
超声心动图已被提议作为筛查儿童风湿性心脏病的一种方法。世界心脏联盟已制定了超声心动图筛查指南。在本研究中，我们根据世界心脏联盟的指南，在风湿性心脏病流行的萨摩亚描述了一种快速超声心动图筛查方案。
2013年至2015年期间，我们对萨摩亚的学童进行了超声心动图筛查。对所有学生进行了简短的筛查超声心动图检查。对符合风湿性心脏病可疑预定义标准的儿童进行更全面的超声心动图检查。完整的超声心动图根据世界心脏联盟的指南和瓣膜疾病的严重程度进行分类。
对11434名儿童进行了超声心动图筛查，平均年龄为10.2岁；其中51%为女性。共有558名（4.8%）儿童接受了全面的超声心动图检查，包括49名随机选择作为对照的学生。在115名学生中观察到明确的风湿性心脏病（每1000人中有10.0人）：92名学生被归类为临界病例（每1000人中有8.0人），23名患有先天性心脏病。在50名学生中发现了晚期疾病（每1000人中有4.4人）：15名患有严重二尖瓣反流，5名患有严重主动脉反流，11名患有二尖瓣狭窄，19名患有二尖瓣和主动脉瓣疾病。
我们在短时间内（3年时间内进行了28天的筛查）成功地将快速超声心动图筛查方案应用于大量学生，以确定风湿性心脏病的高患病率。我们还报告了与先前发表的超声心动图筛查项目相比，晚期疾病的发生率显著更高。
