Cardiovascular Journal of Africa: Vol 26 No 5 (September/October 2015)

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CARDIOVASCULAR JOURNAL OF AFRICA • Vol 26, No 5, October/November 2015 38 AFRICA
Conclusions: The incidence of symptomatic RHD in adults and
the prevalence of asymptomatic RHD in schoolchildren are
high in South Africa. The mortality rate was high in patients
with RHD-related heart failure, although post-surgical morbid-
ity and mortality rates were low. Mortality attributed to RHD
may be falling at a population level.
EVALUATION OF A FOCUSED PROTOCOL FOR HAND-
HELD ECHOCARDIOGRAPHY AND COMPUTER-
ASSISTED AUSCULTATION IN DETECTING LATENT
RHEUMATIC HEART DISEASE IN SCHOLARS
Zühlke Liesl*, Engel ME, Nkepu S, Mayosi BM
Department of Medicine, Groote Schuur Hospital, Cape Town,
South Africa;
Introduction: Echocardiography is the diagnostic test of choice
for latent rheumatic heart disease. The utility of echocardiog-
raphy for large-scale screening is limited by high cost, complex
diagnostic protocols, and time to acquire multiple images. We
evaluated the performance of a brief hand-held echocardiog-
raphy protocol and computer-assisted auscultation in detecting
latent rheumatic heart disease with or without pathological
murmur.
Methods: Twenty-seven asymptomatic participants with latent
rheumatic heart disease, based on World Heart Federation
criteria, and 66 healthy controls were examined by standard
cardiac auscultation to detect pathological murmur. Hand-held
echocardiography using a focused protocol, which utilises one
view (i.e. parasternal long axis) and one measurement (i.e. mitral
regurgitant jet) and computer-assisted auscultation utilising an
automated decision tool were performed on all participants.
Results: The sensitivity and specificity of computer-assisted
auscultation in latent rheumatic heart disease was 4% (95%
CI: 1.0–20.4%) and 93.7% (95% CI: 84.5–98.3%), respectively.
The sensitivity and specificity of the focused hand-held echo-
cardiography protocol for definite rheumatic heart disease was
92.3% (95% CI: 63.9–99.8%) and 100%, respectively. The test
reliability of hand-held echocardiography was 98.7% for definite
and 94.7% for borderline disease, and adjusted diagnostic odds
ratios were 1 041 and 263.9 for definite and borderline disease,
respectively.
Conclusion: Computer-assisted auscultation had an extremely
low sensitivity but high specificity for pathological murmur in
latent rheumatic heart disease. Focused hand-held echocardiog-
raphy had a fair sensitivity but high specificity and diagnostic
utility for definite or borderline rheumatic heart disease in
asymptomatic participants.