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Echocardiographic screening for subclinical rheumatic heart disease remains a research tool pending studies of impact on prognosis.
[acute rheumatic fever]
The
application
of
portable
echocardiography
to
the
screening
of
asymptomatic
children
and
young
adults
for
rheumatic
heart
disease
(
RHD
)
in
developing
countries
indicates
that
the
disease
may
affect
62
million
to
78
million
individuals
worldwide
,
which
could
potentially
result
in
1
.
4
million
deaths
per
year
from
RHD
and
its
complications
.
The
World
Heart
Federation
has
developed
a
guideline
for
the
echocardiographic
diagnosis
of
RHD
in
asymptomatic
individuals
without
a
history
of
acute
rheumatic
fever
(
ARF
)
in
order
to
ensure
the
reliability
,
comparability
,
and
reproducibility
of
findings
of
the
echocardiographic
screening
studies
.
Early
studies
suggest
that
a
third
of
individuals
with
asymptomatic
subclinical
RHD
revert
to
normal
echocardiographic
findings
on
repeat
testing
after
6
-
12
months
,
suggesting
that
repeat
echocardiography
may
be
necessary
to
confirm
the
findings
prior
to
consideration
of
interventions
such
as
antibiotic
prophylaxis
.
It
is
not
known
,
however
,
whether
echocardiographic
screening
for
asymptomatic
subclinical
RHD
or
the
introduction
of
antibiotic
prophylaxis
for
affected
individuals
improves
the
prognosis
of
RHD
.
Furthermore
,
the
cost-effectiveness
of
this
screening
method
has
not
been
established
in
the
vast
majority
of
affected
countries
.
Therefore
,
echocardiographic
screening
for
asymptomatic
subclinical
RHD
remains
a
research
tool
until
studies
of
impact
on
prognosis
and
cost-effectiveness
are
conducted
.
