Rheumatic Fever

From: World Heart Federation [mailto:info@worldheart.org]
Sent: Dienstag, 28. Februar 2012 11:45
To: marianne.bdf@vtx.ch
Subject: International Guidelines for Echocardiographic Diagnosis of Rheumatic Heart Disease

PRESS RELEASE World Heart Federation Publishes First International Guidelines for echocardiographic Diagnosis of Rheumatic Heart Disease Geneva, Tuesday 28 February 2012 – 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 Reményi, 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. Read the full release and view the guidelines >

********New aim to detect rheumatic heart disease early

FEBRUARY 28, 2012 Lisa Nainggolan

Casuarina, Australia - The first evidence-based guidelines on how to use echocardiography to diagnose rheumatic heart disease in those with mild asymptomatic disease have been published, by Dr Bo Reményi (Menzies School of Health Research, Casuarina, Australia) and colleagues in Nature Reviews: Cardiology [1].

The main aim of the new guidelines—which have been written by 21 key researchers in rheumatic heart disease and endorsed by the World Heart Federation (WHF)—"is to allow rapid and early detection of rheumatic heart disease in those individuals who've got mild disease, because they have the most to benefit from early intervention, which is penicillin injections," Reményi told heartwire. Starting this so-called secondary prophylaxis at an earlier stage of the illness than was previously possible can potentially reduce morbidity and mortality, she explained.

The advent of echocardiography has improved the diagnosis of rheumatic heart disease in the past decade—compared with the old method of using a stethoscope—but different criteria to define abnormalities of cardiac valve structure and function have been adopted in various guidances, leading to some confusion, say the researchers.

They hope the development of these new, internationally endorsed standardized diagnostic criteria will help in the design of new studies to evaluate the role of echo in rheumatic heart disease control./.../