Rheumatic Heart Disease Screening by Echocardiography: The Inadequacy of World Health Organization Criteria for Optimizing the Diagnosis of Subclinical Disease
Circulation
Issue: Volume 120(8), 25 August 2009, pp 663-668
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Methods and Results—: We screened 2170 randomly selected school children aged 6 to 17 years in Maputo, Mozambique, clinically and by a portable ultrasound system. Two different echocardiographic sets of criteria for RHD were assessed: “WHO” (exclusively Doppler-based) and “combined” (Doppler and morphology-based) criteria. Independent investigators reviewed all suspected RHD cases using a higher-resolution, nonportable ultrasound system. On-site echocardiography identified 18 and 124 children with suspected RHD according to WHO and combined criteria, respectively. After consensus review, 17 were finally considered to have definite RHD according to WHO criteria, and 66 had definite RHD according to combined criteria, giving prevalence rates of 7.8 (95% confidence interval, 4.6 to 12.5) and 30.4 (95% confidence interval, 23.6 to 38.5) per 1000 children, respectively (P<0.0001, exact McNemar test).
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Estudo demonstra a importância dos detalhes anatômicos para definição da valvopatia reumática.
Algo que falta muitas vezes nos ecocardiografistas treinados mais ao sul do Brasil, dado o pouco contato com a patologia inicial.
Na UNICAMP vemos dezenas de casos por ano de sequelas avançadas mas poucos casos iniciais.
Precisamos nos preparar para casos mais sutis da doença.
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