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Abstract：
The World Heart Federation (WHF) published the first evidence-based guidelines on the echocardiographic diagnosis of rheumatic heart disease (RHD) in 2012. These guidelines have since been applied internationally in research and clinical practice. Substantial research has assessed the utility of the 2012 WHF criteria, including its applicability in low-resource settings. This article summarises the evidence regarding the performance of the guidelines.
A scoping review assessing the performance of the guidelines was performed. Cochrane, Embase, Medline, PubMed Lilacs, Sielo, and Portal BVS databases were searched for studies on the performance of the guidelines between January 2012-March 2023, and 4047 manuscripts met the search criteria, of which 34 were included. This included papers assessing the specificity, inter-rater reliability, application using hand-carried ultrasound, and modification of the criteria for simplicity. The review followed the PRISMA Extension for Scoping Reviews guideline.
The WHF 2012 criteria were 100% specific for definite RHD when applied in low-prevalence populations. The criteria demonstrated substantial and moderate inter-rater reliability for detecting definite and borderline RHD, respectively. The inter-rater reliability for morphological features was lower than for valvular regurgitation. When applied to hand-carried ultrasound performed by an expert, modified versions of the criteria demonstrated a sensitivity and specificity range of 79-90% and 87-93% respectively for detecting any RHD, performing best for definite RHD. The sensitivity and the specificity were reduced when performed in task-sharing but remains moderately accurate.
The WHF 2012 criteria provide clear guidance for the echocardiographic diagnosis of RHD that is reproducible and applicable to a range of echocardiographic technology. Furthermore, the criteria are highly specific and particularly accurate for detecting definite RHD. There are limitations in applying all aspects of the criteria in specific settings, including task-sharing. This summary of evidence can inform the updated version of the WHF guidelines to ensure improved applicability in all RHD endemic regions.
A scoping review assessing the performance of the guidelines was performed. Cochrane, Embase, Medline, PubMed Lilacs, Sielo, and Portal BVS databases were searched for studies on the performance of the guidelines between January 2012-March 2023, and 4047 manuscripts met the search criteria, of which 34 were included. This included papers assessing the specificity, inter-rater reliability, application using hand-carried ultrasound, and modification of the criteria for simplicity. The review followed the PRISMA Extension for Scoping Reviews guideline.
The WHF 2012 criteria were 100% specific for definite RHD when applied in low-prevalence populations. The criteria demonstrated substantial and moderate inter-rater reliability for detecting definite and borderline RHD, respectively. The inter-rater reliability for morphological features was lower than for valvular regurgitation. When applied to hand-carried ultrasound performed by an expert, modified versions of the criteria demonstrated a sensitivity and specificity range of 79-90% and 87-93% respectively for detecting any RHD, performing best for definite RHD. The sensitivity and the specificity were reduced when performed in task-sharing but remains moderately accurate.
The WHF 2012 criteria provide clear guidance for the echocardiographic diagnosis of RHD that is reproducible and applicable to a range of echocardiographic technology. Furthermore, the criteria are highly specific and particularly accurate for detecting definite RHD. There are limitations in applying all aspects of the criteria in specific settings, including task-sharing. This summary of evidence can inform the updated version of the WHF guidelines to ensure improved applicability in all RHD endemic regions.
摘要：
世界心脏联合会（WHF）于2012年发布了有关风湿性心脏病（RHD）超声心动图诊断的首个循证指南。这些指南已在国际上应用于研究和临床实践。大量研究评估了2012年WHF标准的实用性，包括其在低资源环境中的适用性。本文总结了有关指南性能的证据。
■进行了评估指南性能的范围审查。科克伦,Embase,Medline,PubMed丁香,Sielo,和PortalBVS数据库在2012年1月至2023年3月之间进行了指南性能研究，4047份手稿符合搜索标准，其中包括34个。这包括评估特异性的论文，评分者间的可靠性，使用手提超声的应用，为了简单起见，对标准进行了修改。审查遵循了PRISMA扩展范围审查指南。
■在低患病率人群中应用时，WHF2012标准对明确的RHD具有100％的特异性。该标准证明了用于检测明确和边界RHD的评估者间可靠性，分别。形态学特征的评估者间可靠性低于瓣膜反流。当应用于由专家执行的手提超声时，标准的修改版本显示检测任何RHD的敏感性和特异性范围分别为79-90％和87-93％，对于明确的RHD表现最好。在任务共享中执行时，灵敏度和特异性降低，但仍保持中等准确性。
■WHF2012标准为RHD的超声心动图诊断提供了明确的指导，该指导具有可重复性，适用于一系列超声心动图技术。此外，该标准具有高度特异性，对于检测明确的RHD特别准确。在特定设置中应用标准的所有方面都存在局限性，包括任务共享。此证据摘要可以为WHF指南的更新版本提供信息，以确保在所有RHD流行地区的适用性得到改善。
■进行了评估指南性能的范围审查。科克伦,Embase,Medline,PubMed丁香,Sielo,和PortalBVS数据库在2012年1月至2023年3月之间进行了指南性能研究，4047份手稿符合搜索标准，其中包括34个。这包括评估特异性的论文，评分者间的可靠性，使用手提超声的应用，为了简单起见，对标准进行了修改。审查遵循了PRISMA扩展范围审查指南。
■在低患病率人群中应用时，WHF2012标准对明确的RHD具有100％的特异性。该标准证明了用于检测明确和边界RHD的评估者间可靠性，分别。形态学特征的评估者间可靠性低于瓣膜反流。当应用于由专家执行的手提超声时，标准的修改版本显示检测任何RHD的敏感性和特异性范围分别为79-90％和87-93％，对于明确的RHD表现最好。在任务共享中执行时，灵敏度和特异性降低，但仍保持中等准确性。
■WHF2012标准为RHD的超声心动图诊断提供了明确的指导，该指导具有可重复性，适用于一系列超声心动图技术。此外，该标准具有高度特异性，对于检测明确的RHD特别准确。在特定设置中应用标准的所有方面都存在局限性，包括任务共享。此证据摘要可以为WHF指南的更新版本提供信息，以确保在所有RHD流行地区的适用性得到改善。
