World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease-an evidence-based guideline

Bo Reméanyi, Nigel Wilson, Andrew Steer, Beatriz Ferreira, Joseph Kado, Krishna Kumar, John Lawrenson, Graeme Maguire, Eloi Marijon, Mariana Mirabel, Ana Olga Mocumbi, Cleonice Mota, John Paar, Anita Saxena, Janet Scheel, John Stirling, Satupaitea Viali, Vijayalakshmi I. Balekundri, Gavin Wheaton, Liesl ZühlkeJonathan Carapetis

Research output: Contribution to journalReview article

Abstract

Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: 'definite RHD', 'borderline RHD', and 'normal'. Four subcategories of 'definite RHD' and three subcategories of 'borderline RHD' exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control.

Original languageEnglish (US)
Pages (from-to)297-309
Number of pages13
JournalNature Reviews Cardiology
Volume9
Issue number5
DOIs
StatePublished - May 2012

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Reméanyi, B., Wilson, N., Steer, A., Ferreira, B., Kado, J., Kumar, K., Lawrenson, J., Maguire, G., Marijon, E., Mirabel, M., Mocumbi, A. O., Mota, C., Paar, J., Saxena, A., Scheel, J., Stirling, J., Viali, S., Balekundri, V. I., Wheaton, G., ... Carapetis, J. (2012). World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease-an evidence-based guideline. Nature Reviews Cardiology, 9(5), 297-309. https://doi.org/10.1038/nrcardio.2012.7