Royal Darwin Hospital, Darwin, NT, Australia; Menzies School of Health Research, Darwin, NT, Australia.
Royal Darwin Hospital, Darwin, NT, Australia; Hospital Nacional Guido Valadares, Dili, Timor-Leste.
Heart Lung Circ. 2020 Jun;29(6):859-866. doi: 10.1016/j.hlc.2019.02.196. Epub 2019 Jun 11.
Echocardiographic screening in school-aged children can detect rheumatic heart disease (RHD) prior to the manifestation of symptoms of heart failure. The challenge is making this practical and affordable on a global scale. This study aims to evaluate the diagnostic utility of an ultra-abbreviated echocardiographic screening protocol involving a single parasternal-long-axis-view-sweep of the heart (SPLASH) in two dimensional (2D) and colour Doppler imaging (index test).
This prospective study of diagnostic accuracy compared the diagnostic utility of the index screening test with a comprehensive reference test (standard echocardiographic screening protocols) as per World Heart Federation (WHF) echocardiographic criteria. School students in Timor-Leste aged 5-20 years were enrolled. Both index and reference test images were acquired by cardiologists on Vivid I or Q machines (GE Healthcare, Marlborough, MA, USA).
A total of 1,365 participants were screened; median age was 11 years. The estimated prevalence of definite and borderline RHD was 35.2 per 1,000. Congenital heart disease was identified in 11 children (0.8%) with two needing cardiac surgery. Abnormal SPLASH views were found in 109/1365 (7.99%). No cases of RHD or significant congenital heart disease were missed. Sensitivity and specificity of the abbreviated protocol for detecting RHD were 1.0 and 0.95 respectively.
A simplified echocardiography screening protocol using SPLASH is highly sensitive and specific and could significantly improve the efficiency of RHD screening. It has the potential to expedite training of health workers whilst protecting the modesty of students.
在出现心力衰竭症状之前，通过对学龄儿童进行超声心动图筛查，可以发现风湿性心脏病（RHD）。目前的挑战是在全球范围内实现这一目标的实用性和可负担性。本研究旨在评估一种超简化的超声心动图筛查方案的诊断效能，该方案包括二维（2D）和彩色多普勒成像的单个心前区长轴扫描（SPLASH）（指标测试）。
本前瞻性诊断准确性研究将索引筛查试验与综合参考试验（根据世界心脏联合会（WHF）超声心动图标准进行的标准超声心动图筛查方案）进行了比较。东帝汶的学龄儿童（5-20 岁）参加了这项研究。索引和参考测试图像均由心脏病专家使用 Vivid I 或 Q 机器（GE Healthcare，马萨诸塞州马尔伯勒）获取。
共筛查了 1365 名参与者；中位数年龄为 11 岁。估计明确和边缘型 RHD 的患病率为每 1000 人中有 35.2 例。11 名儿童（0.8%）发现了先天性心脏病，其中 2 名需要心脏手术。在 1365 名儿童中，有 109 名（7.99%）存在异常 SPLASH 视图。没有漏诊 RHD 或严重先天性心脏病的病例。简化方案检测 RHD 的敏感性和特异性分别为 1.0 和 0.95。
使用 SPLASH 的简化超声心动图筛查方案具有较高的敏感性和特异性，可显著提高 RHD 筛查的效率。它有可能在保护学生隐私的同时，加快卫生工作者的培训。
