James Barron Anthony, Aijigitov Turgunbai, Baltabaeva Aigul
Harefield Hospital, Royal Brompton and Harefield NHS Trust, London, UK.
Batken District General Hospital, Batken, Kyrgyzstan.
JRSM Cardiovasc Dis. 2018 Jun 9;7:2048004018779736. doi: 10.1177/2048004018779736. eCollection 2018 Jan-Dec.
Cardiovascular disease accounts for 42% of male and 51% of female mortality within Europe. Kyrgyzstan, population of almost 6 million, has amongst the highest rates within Europe, second only to Uzbekistan for female cardiovascular disease mortality (588 per 100,000). We attempted to identify established cardiovascular disease prevalence within a rural community in Kyrgyzstan using portable echocardiography.
Free open access echocardiography (VIVID-I, GE, USA) was offered to all adults in Batken district. Routine echocardiographic views were obtained and analysis performed using EchoPac Clinical Workstation (GE, USA). Mild valvular regurgitation, mild LV hypertrophy, patent foramen ovales and mild atrial enlargement were considered mild abnormalities; compensated ischaemic or valvular heart disease - moderate abnormalities, and decompensated congenital, ischaemic or valvular disease - severe abnormalities.
One hundred and twenty five adults (48 male, 77 female), mean age 53 ± 16 years, underwent echocardiography. Only 16% of participants had no significant abnormality, 46% had mild disease, 25% moderate, compensated disease and 13% had severe disease. Nine percent had congenital heart disease including one tetralogy of Fallot and one Ebstein's anomaly. Average LV function was normal, however, 19 participants had EF < 50%. Forty percent of participants had a new diagnosis warranting formal follow-up, 12% a new diagnosis of heart failure.
Using portable echocardiography, we identify a higher than reported prevalence of cardiovascular disease in rural Kyrgyzstan. Absence of portable tools and specialists for early diagnosis might lead to presentation in an advanced stage of disease when little can be done to improve mortality. Embracing remote access diagnostics is essential for disease identification within rural communities.
在欧洲，心血管疾病导致的死亡率在男性中占42%，在女性中占51%。吉尔吉斯斯坦人口近600万，其心血管疾病死亡率在欧洲位居前列，女性心血管疾病死亡率仅次于乌兹别克斯坦（每10万人中有588例）。我们试图通过便携式超声心动图确定吉尔吉斯斯坦一个农村社区中已确诊的心血管疾病患病率。
向巴特肯地区的所有成年人提供免费的开放式超声心动图检查（美国通用电气公司的VIVID-I）。获取常规超声心动图图像，并使用美国通用电气公司的EchoPac临床工作站进行分析。轻度瓣膜反流、轻度左心室肥厚、卵圆孔未闭和轻度心房扩大被视为轻度异常；代偿性缺血性或瓣膜性心脏病为中度异常，失代偿性先天性、缺血性或瓣膜性疾病为重度异常。
125名成年人（48名男性，77名女性）接受了超声心动图检查，平均年龄53±16岁。只有16% 的参与者没有明显异常，46% 患有轻度疾病，25% 患有中度代偿性疾病，13% 患有重度疾病。9% 的人患有先天性心脏病，包括1例法洛四联症和1例埃布斯坦畸形。左心室平均功能正常，然而，19名参与者的射血分数（EF）<50%。40% 的参与者有新诊断结果，需要进行正式随访，12% 被新诊断为心力衰竭。
通过便携式超声心动图检查，我们发现吉尔吉斯斯坦农村地区心血管疾病的患病率高于报告水平。缺乏早期诊断的便携式工具和专家可能导致疾病在晚期才被发现，此时改善死亡率的措施收效甚微。采用远程诊断对于农村社区疾病的识别至关重要。
