ArticleEuropean heart journal open2021
Screening for subclinical rheumatic heart disease: addressing borderline disease in a real-world setting.
Article in European heart journal open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Global prevalence and sex differences in rheumatic heart disease: a systematic review and updated meta-analysis.Frontiers in cardiovascular medicine · 2025Pooled it
- Article
- Detection and management of latent rheumatic heart disease: a narrative review.Annals of medicine and surgery (2012) · 2023Review
- Cardiac imaging in rheumatic heart disease and future developments.European heart journal open · 2023Review
- The role of echocardiographic screening in reducing the burden of rheumatic heart disease in Latin America.Revista panamericana de salud publica = Pan American journal of public health · 2023Article
- Early surgery determines prognosis in patients with infective endocarditis: outcome in patients managed by an Endocarditis Team-a prospective cohort study.Cardiovascular diagnosis and therapy · 2022Article
- Modified Duke/European Society of Cardiology 2015 clinical criteria for infective endocarditis: time for an update?Open heart · 2022Article
- Calcific aortic valve stenosis and COVID-19: clinical management, valvular damage, and pathophysiological mechanisms.Cardiology plus · 2022Review
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Authors and funding
7 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Aims: The World Heart Federation (WHF) criteria identify a large borderline rheumatic heart disease (RHD) category that has hampered the implementation of population-based screening. Inter-scallop separations (ISS) of the posterior mitral valve leaflet, a recently described normal variant of the mitral valve, appears to be an important cause of mild mitral regurgitation (MR) leading to misclassification of cases as WHF 'borderline RHD'. This study aims to report the findings of the Echo in Africa project, a large-scale RHD screening project in South Africa and determine what proportion of borderline cases would be re-classified as normal if there were a systematic identification of ISS-related MR. Methods and results: A prospective cross-sectional study of underserved secondary schools in the Western Cape was conducted. Participants underwent a screening study with a handheld (HH) ultrasound device. Children with an abnormal HH study were re-evaluated with a portable laptop echocardiography machine. A mechanistic evaluation was applied in cases with isolated WHF 'pathological' MR (WHF 'borderline RHD'). A total of 5255 participants (mean age 15± years) were screened. A total of 3439 (65.8%) were female. Forty-nine cases of WHF 'definite RHD' [9.1 cases/1000 (95% confidence interval, CI, 6.8-12.1 cases/1000)] and 104 cases of WHF 'borderline RHD' [19.5 cases/1000 (95% CI, 16.0-23.7 cases/1000)] were identified. Inter-scallop separations-related MR was the underlying mechanism of MR in 48/68 cases classified as WHF 'borderline RHD' with isolated WHF 'pathological' MR (70.5%). Conclusion: In a real-world, large-scale screening project, the adoption of a mechanistic evaluation based on the systematic identification of ISS-related MR markedly reduced the number of WHF 'screen-positive' cases misclassified as WHF 'borderline RHD'. Implementing strategies that reduce this misclassification could reduce the cost- and labour burden on large-scale RHD screening programmes.
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