背景:早期发现和诊断急性风湿热和风湿性心脏病是预防疾病进展的关键,超声心动图具有重要的诊断作用。标准超声心动图在高流行地区可能不可行,因为它的高成本,复杂性,和时间要求。手持式超声心动图可能是一种易于使用的,低成本的替代品,但其在急性风湿热和风湿性心脏病筛查和诊断中的表现需要进一步研究。
方法:在本系统综述和荟萃分析中,我们搜索了Embase,MEDLINE,LILACS,和截至2024年2月9日的会议论文集引文索引-科学,用于在高患病率地区使用手持式超声心动图(指数测试)或标准超声心动图或听诊(参考测试)筛查和诊断急性风湿热和风湿性心脏病的研究。我们纳入了所有具有可用数据的研究,其中指数测试的诊断性能与参考测试进行了评估。诊断风湿性心脏病的测试准确性数据,急性风湿热,或急性风湿热的心脏炎(主要结果)从发表的文章中提取或计算,必要时联系作者。使用GRADE和QUADAS-2标准评估证据质量。我们总结了诊断准确性统计数据(包括敏感性和特异性),并使用双变量随机效应模型(或用于分析的单变量随机效应模型,包括三项或更少研究)估计了95%CI。曲线下面积(AUC)由概括的接受者工作特征曲线计算。通过目视检查地块来评估异质性。本研究在PROSPERO(CRD42022344081)注册。
结果:在4868条记录中,我们确定了11项研究,还有两份报告,由15578名独特参与者组成。汇总数据显示,手持式超声心动图具有较高的敏感性(0·87[95%CI0·76-0·93]),特异性(0·98[0·71-1·00]),与标准超声心动图相比,诊断风湿性心脏病的总体准确性高(AUC0·94[0·84-1·00])(两项研究;证据的中等确定性),与临界风湿性心脏病相比,具有更好的诊断明确的性能。高灵敏度(0·79[0·73-0·84]),特异性(0·85[0·80-0·89]),在收集手持式超声心动图与标准超声心动图的数据时,观察到风湿性心脏病筛查的总体准确性(AUC0·90[0·85-0·94])(7项研究;证据确定性高).大多数研究总体偏倚风险较低。在研究中观察到一些异质性的敏感性和特异性,可能是由于风湿性心脏病患病率和严重程度的差异,以及非专家操作员的培训或专业知识水平。
结论:与标准超声心动图相比,手持式超声心动图在风湿性心脏病高患病率地区的诊断和筛查具有较高的准确性和诊断性能。
背景:世界卫生组织。
■对于中国人,法语,意大利语,波斯语,葡萄牙语,摘要的西班牙语和乌尔都语翻译见补充材料部分。
BACKGROUND: Early detection and diagnosis of acute rheumatic fever and rheumatic heart disease are key to preventing progression, and echocardiography has an important diagnostic role. Standard echocardiography might not be feasible in high-prevalence regions due to its high cost, complexity, and time requirement. Handheld echocardiography might be an easy-to-use, low-cost alternative, but its performance in screening for and diagnosing acute rheumatic fever and rheumatic heart disease needs further investigation.
METHODS: In this systematic review and meta-analysis, we searched Embase, MEDLINE, LILACS, and Conference Proceedings Citation Index-Science up to Feb 9, 2024, for studies on the screening and diagnosis of acute rheumatic fever and rheumatic heart disease using handheld echocardiography (index test) or standard echocardiography or auscultation (reference tests) in high-prevalence areas. We included all studies with useable data in which the diagnostic performance of the index test was assessed against a reference test. Data on test accuracy in diagnosing rheumatic heart disease, acute rheumatic fever, or carditis with acute rheumatic fever (primary outcomes) were extracted from published articles or calculated, with authors contacted as necessary. Quality of evidence was appraised using GRADE and QUADAS-2 criteria. We summarised diagnostic accuracy statistics (including sensitivity and specificity) and estimated 95% CIs using a bivariate random-effects model (or univariate random-effects models for analyses including three or fewer studies). Area under the curve (AUC) was calculated from summary receiver operating characteristic curves. Heterogeneity was assessed by visual inspection of plots. This study was registered with PROSPERO (CRD42022344081).
RESULTS: Out of 4868 records we identified 11 studies, and two additional reports, comprising 15 578 unique participants. Pooled data showed that handheld echocardiography had high sensitivity (0·87 [95% CI 0·76-0·93]), specificity (0·98 [0·71-1·00]), and overall high accuracy (AUC 0·94 [0·84-1·00]) for diagnosing rheumatic heart disease when compared with standard echocardiography (two studies; moderate certainty of evidence), with better performance for diagnosing definite compared with borderline rheumatic heart disease. High sensitivity (0·79 [0·73-0·84]), specificity (0·85 [0·80-0·89]), and overall accuracy (AUC 0·90 [0·85-0·94]) for screening rheumatic heart disease was observed when pooling data of handheld echocardiography versus standard echocardiography (seven studies; high certainty of evidence). Most studies had a low risk of bias overall. Some heterogeneity was observed for sensitivity and specificity across studies, possibly driven by differences in the prevalence and severity of rheumatic heart disease, and level of training or expertise of non-expert operators.
CONCLUSIONS: Handheld echocardiography has a high accuracy and diagnostic performance when compared with standard echocardiography for diagnosing and screening of rheumatic heart disease in high-prevalence areas.
BACKGROUND: World Health Organization.
UNASSIGNED: For the Chinese, French, Italian, Persian, Portuguese, Spanish and Urdu translations of the abstract see Supplementary Materials section.