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. 2004 Jul;60(3):255-8.
doi: 10.1016/S0377-1237(04)80058-3. Epub 2011 Jul 21.

Clinical Evaluation Versus Echocardiography in the Assessment of Rheumatic Heart Disease

Ashwin Reddy  1 , S K Jatana  2 , Mng Nair  3
Affiliations

Clinical Evaluation Versus Echocardiography in the Assessment of Rheumatic Heart Disease

Ashwin Reddy et al. Med J Armed Forces India. 2004 Jul.

Abstract

Background: Rheumatic heart disease (RHD) is still a common form of heart disease among children and young adults, especially in developing countries like India. Between 1940 and 1983, the prevalence rate of RHD varied from 1.8 to 11 per 1000 (national average 6 per 1000), while between 1984 and 1995 the rate varied from 1 to 5.4 per 1000 [1]. The study was carried out to assess the accuracy of a medical student's clinical evaluation of valvular heart disease and compare it with that of an echocardiographic evaluation and to determine the sensitivity, specificity and predictive values of clinical examination as compared to echocardiography for the various lesions in RHD patients.

Method: 50 children between the ages of 5-16 years, attending the out patient department or admitted in a large teaching hospital, satisfying the criteria of RHD, were included in the study. Each patient underwent detailed clinical evaluation and relevant investigations including echocardiography.

Results: Mitral valve was involved most often both by echocardiography and clinically. Isolated aortic valve involvement was rare. The most common lesion was mitral regurgitation (MR) both by auscultation and by echo. Mixed lesions were seen more often than pure lesions. Mitral stenosis (MS) had the highest sensitivity while tricuspid regurgitation (TR) had the highest specificity. MR had the highest positive predictive value and MS the highest negative predictive value. Sensitivity and specificity of aortic regurgitation (AR) was very low when compared to earlier studies. There was a statistically significant difference between echo diagnosis and clinical diagnosis (p < 0.05).

Conclusion: It is recommended that echocardiography be done routinely for the diagnosis of cardiac lesions in patients of RHD as clinical examination alone can miss various lesions, especially when the lesions are mild or when multiple lesions are present.

Keywords: Aortic valve; Children; Mitral valve; Rheumatic heart disease; Tricuspid valve.

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Figures

Fig. 1
Fig. 1
Distribution of various lesions:clinical vs echocardiography MS- mitral stenosis, MR - mitral regurgitation, AR - aortic regurgitation, TR - tricuspid regurgitation
Fig. 2
Fig. 2
The sensitivity, specificity, predictive values of clinical examination MS- mitral stenosis, MR - mitral regurgitation, AR - aortic regurgitation, TR - tricuspid regurgitation Sens - sensitivity, Spec - specificity, +ve PV - positive predictive value, -ve PV - negative predictive value
Fig. 3
Fig. 3
The sensitivity, specificity, predictive values are compared to other studies MS- mitral stenosis, MR - mitral regurgitation, AR - aortic regurgitation, TR - tricuspid regurgitation Sens - sensitivity, Spec - specificity, PPV - positive predictive value
See this image and copyright information in PMC

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References

    1. Padmavati S. Rheumatic heart disease: prevalence and preventive measures in the Indian subcontinent. Heart. 2001;86(2):127. - PMC - PubMed
    1. Shaver JA. Cardiac Auscultation: A cost effective diagnostic skill. Current problems in Cardiology. 1995:446–521. - PubMed
    1. Saxena A. Diagnosis of Rheumatic fever: current status of Jones criteria and role of echocardiography. Indian Journal of Paediatrics. 2000;67(4):283–286. - PubMed
    1. Jaffe WM, Roche Antony HG, Coverdale HA, McAlister HF, Ormiston JA, Greene ER. Clinical evaluation versus Doppler echocardiography in the quantitative assessment of valvular heart disease. Circulation. 1988;78(2):267–275. - PubMed
    1. Paul AG, Smith MD, Rodney H, Bruce JF, Antony ND. Detection of Aortic Insufficiency by standard echocardiography, pulsed Doppler echocardiography, and auscultation. Annals of Internal Medicine. 1986;104:599–605. - PubMed