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First international guidelines released for ECG diagnosis of rheumatic heart disease
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The first international guidelines addressing the diagnosis of rheumatic heart disease using echocardiography in patients with no history of acute rheumatic fever were recently published by the World Heart Federation in Nature Reviews Cardiology.
Diagnosis of rheumatic heart disease using ECG can be missed when physicians only use clinical experience without any definitive guidance. With standardized criteria, physicians can rapidly and consistently identify patients with rheumatic heart disease without a clear history of acute rheumatic fever, allowing enrollment into secondary prophylaxis programs.
“The new evidence-based guidelines clearly define not only what is considered to be a definite and a borderline case of [rheumatic heart disease] but also what is considered normal in children,” Bo Reményi, MD, of the Menzies School of Health Research in Darwin, Australia, said in a press release. “The aim of the guidelines is to maximize pick-up of minor degrees of rheumatic heart disease, while preventing over-diagnosis.”
Three categories were defined on the basis of assessment by 2-D, continuous-wave and color-Doppler ECG:
- Definite rheumatic heart disease
- Borderline rheumatic heart disease.
- Normal.
Four subcategories of definite rheumatic heart disease and three subcategories of borderline rheumatic heart disease were also defined to reflect the various disease patterns. The guidelines also define morphological features of rheumatic heart disease and criteria for pathological aortic and mitral regurgitation.
“The diagnostic ECG definitions of rheumatic heart disease in these guidelines have been made on the basis of the best available evidence at this time and will need revision in the future, as more experience is gained and research is performed,” the authors wrote.
The aim of the guidelines is to “permit rapid and consistent identification of individuals with rheumatic heart disease without a clear history of acute rheumatic fever.” Doing so will allow enrollment into secondary prophylaxis programs, according to the authors.
The authors note that questions remain about the importance of subclinical disease and about the practicalities of implementing screening programs for rheumatic heart disease.
“These standardized criteria will help enable new studies to be designed to evaluate the role of ECG screening in rheumatic heart disease control,” the authors concluded.
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Disclosure: Dr. Reményi reports funding by the Lowitja Institute of Australia.