New guidelines for detection of rheumatic heart disease

The inaugural international guidelines for the diagnosis of rheumatic heart disease (RHD), a disease that affects tens of millions of people worldwide, have today been published by the World Heart Federation in Nature Reviews Cardiology.

The guidelines define the minimum requirements needed to diagnose RHD in individuals without a clear history of acute rheumatic fever (ARF), and will have important global and national implications.

Diagnosis is conducted with an ultrasound of the heart's valves and chambers, known as an echocardiogram, but currently no guidelines are available to define what is normal on echocardiography.

In the absence of definitive guidance, physicians reporting on echocardiograms make decisions based on their clinical experience, and missing the disease at an early stage can have devastating consequences.

"The new evidence-based guidelines clearly define not only what is considered to be a definite and a borderline case of RHD but also what is considered normal in children," said Dr Bo Rem-nyi, Menzies School of Health Research, Darwin, Australia. "The aim of the guidelines is to maximise pick-up of minor degrees of RHD, while preventing over-diagnosis."

The World Heart Federation echocardiographic criteria for RHD have been developed and formulated on the basis of the best available evidence.

"The use of the guidelines should enable rapid identification of RHD patients who do not have a history of ARF," said Prof Jonathan Carapetis, a co-author of the guidelines and Director of the Menzies School of Health Research in Darwin, Australia.

Dr Nigel Wilson a co-author and Paediatric Cardiologist from the Starship Children's Hospital, Auckland New Zealand commented that "the guidelines should also allow for consistent echocardiographic reporting of RHD worldwide, which will in turn help us to get a better understanding of the number of people that are truly affected by this disease."

Three categories have been 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.