Evidence map›Paper›PMID 33154146›Full record

ArticleOpen heart2020

Interscallop separations of the posterior mitral valve leaflet: a solution to the 'borderline RHD' conundrum?

Luke David Hunter, Mark Monaghan, Guy Lloyd, Carl Lombard, Alfonso Jan Kemp Pecoraro, Anton Frans Doubell, Philipus George Herbst

Open access · goldAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Open heart, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
1.3field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 9 citations in OpenAlex.

  1. Review
  2. Article
  3. Article
  4. Review
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 2 countries.

Luke David HunterDivision of Cardiology, Department of Medicine, Tygerberg Academic Hospital, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa lukehunter1987@icloud.com.ORCID 0000-0001-7410-1339
Mark MonaghanCardiology, King's College London School of Medical Education, London, United Kingdom.
Guy LloydBarts Heart Centre, St Bartholomew's Hospital, London, United Kingdom.
Carl LombardDivision of Epidemiology and Biostatistics, University of Stellenbosch, Cape Town, Western Cape, South Africa.
Alfonso Jan Kemp PecoraroDivision of Cardiology, Department of Medicine, Tygerberg Academic Hospital, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.
Anton Frans DoubellDivision of Cardiology, Department of Medicine, Tygerberg Academic Hospital, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.
Philipus George HerbstDivision of Cardiology, Department of Medicine, Tygerberg Academic Hospital, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.
Stellenbosch University · ZAKing's College London · GBSt Bartholomew's Hospital · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe World Heart Federation (WHF) criteria incorporate a Doppler-based system to differentiate between 'physiological' and 'pathological' mitral regurgitation (MR)-a sole criterion sufficient for the diagnosis of WHF 'borderline' rheumatic heart disease (RHD). We have identified that interscallop separations (ISS) of the posterior mitral valve (MV) leaflet, can give rise to pathological MR in an otherwise-normal MV. We aimed to establish and compare the prevalence of ISS-related MR among South African children at high and low risk for RHD.

methodsA prospective cross-sectional echocardiographic study of 759 school children (aged 13-18) was performed. Cases with MR≥1.5 cm underwent a second comprehensive study to determine the prevalence of RHD according to the WHF guideline and establish the underlying mechanism of MR.

resultsOf 400 high-risk children, two met criteria for 'definite RHD' (5 per 1000 (95% CI 1.4 to 18.0); p=0.5) and 11 for 'borderline RHD' (27.5 per 1000 (95% CI 15.4 to 48.6)). Of 359 low-risk children, 14 met criteria for borderline RHD (39 per 1000 (95% CI 23.4 to 64.4)). Comprehensive echocardiography identified an underlying ISS as the mechanism of isolated pathological MR in 10 (83.3%) high-risk children and 11 low-risk children (78.5%; p>0.99).

conclusionsISS are a ubiquitous finding among South African schoolchildren from all risk profiles and are regularly identified as the underlying mechanism of WHF pathological MR in borderline RHD cases. A detailed MV assessment with an emphasis on ascertaining the underlying mechanism of dysfunction could reduce the reported numbers of screened cases misclassified as borderline RHD.

Indexed as

Echocardiography, DopplerAdolescentCross-Sectional StudiesDiagnosis, DifferentialFemaleHumansMaleMitral ValveMitral Valve InsufficiencyObserver VariationPredictive Value of TestsPrevalenceProspective StudiesReproducibility of ResultsRheumatic Heart DiseaseRisk Assessmentechocardiographyheart valve diseasesmitral regurgitation

Identifiers

PMID33154146
PMCPMC7646362
OpenAlexW3094974148

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.