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World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease—an evidence-based guideline

Nature Reviews Cardiology volume 9, pages 297–309 (2012)Cite this article

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Abstract

Over the past 5 years, the advent of echocardiographic screening for rheumatic heart disease (RHD) has revealed a higher RHD burden than previously thought. In light of this global experience, the development of new international echocardiographic guidelines that address the full spectrum of the rheumatic disease process is opportune. Systematic differences in the reporting of and diagnostic approach to RHD exist, reflecting differences in local experience and disease patterns. The World Heart Federation echocardiographic criteria for RHD have, therefore, been developed and are formulated on the basis of the best available evidence. Three categories are defined on the basis of assessment by 2D, continuous-wave, and color-Doppler echocardiography: 'definite RHD', 'borderline RHD', and 'normal'. Four subcategories of 'definite RHD' and three subcategories of 'borderline RHD' exist, to reflect the various disease patterns. The morphological features of RHD and the criteria for pathological mitral and aortic regurgitation are also defined. The criteria are modified for those aged over 20 years on the basis of the available evidence. The standardized criteria aim to permit rapid and consistent identification of individuals with RHD without a clear history of acute rheumatic fever and hence allow enrollment into secondary prophylaxis programs. However, important unanswered questions remain about the importance of subclinical disease (borderline or definite RHD on echocardiography without a clinical pathological murmur), and about the practicalities of implementing screening programs. These standardized criteria will help enable new studies to be designed to evaluate the role of echocardiographic screening in RHD control.

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Figure 1: Schematic images of the MV in systole.
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Acknowledgements

We acknowledge the support of RHDAustralia and Heart Association of Thailand in coordinating the investigators' meeting. B. Reményi's research position was funded by research scholarships from the National Heart Foundation of New Zealand and the Lowitja Institute of Australia. N. Wilson was funded part time by the Green Lane Research and Education Fund in 2010. L. Zühlke is supported by the NIH through the international clinical scholars and fellow program (R24 TW007988). Project grants were received from the Medtronic Foundation for the investigators' meeting and from the Green Lane Research and Education Fund for the website development.

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Authors and Affiliations

  1. Green Lane Pediatric and Congenital Cardiac Service, Starship Children's Hospital, Auckland, New Zealand

    Bo Reményi, Nigel Wilson & John Stirling

  2. Royal Children's Hospital, Australia

    Andrew Steer

  3. Maputo Heart Institute, Mozambique

    Beatriz Ferreira

  4. Fiji Ministry of Health, Fiji Islands

    Joseph Kado

  5. Amrita Institute of Medical Sciences, India

    Krishna Kumar

  6. Stellenbosch University, South Africa

    John Lawrenson

  7. James Cook University, Australia

    Graeme Maguire

  8. Hôpital Européen Georges Pompidou, France

    Eloi Marijon & Mariana Mirabel

  9. University Eduardo Mondlane, Mozambique

    Ana Olga Mocumbi

  10. Federal University of Minas Gerais, Brazil

    Cleonice Mota

  11. WakeMed Hospital, USA

    John Paar

  12. All India Institute of Medical Sciences, India

    Anita Saxena

  13. Johns Hopkins Hospital, USA

    Janet Scheel

  14. Medical Specialist Clinic, Samoa

    Satupaitea Viali

  15. Sri Jayadeva Institute of Cardiovascular Sciences and Research, India

    Vijayalakshmi I. Balekundri

  16. Women's and Children's Hospital, Australia

    Gavin Wheaton

  17. University of Cape Town, South Africa

    Liesl Zühlke

  18. Menzies School of Health Research, Australia

    Jonathan Carapetis

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Contributions

B. Reményi wrote the article. All authors researched data for the article, substantially contributed to discussion of the content, and reviewed/edited the manuscript before submission.

Corresponding author

Correspondence to Bo Reményi.

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Supplementary Information

Concise summary of the 2012 World Heart Federation criteria for the echocardiographic diagnosis of rheumatic heart disease (PDF 116 kb)

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Reményi, B., Wilson, N., Steer, A. et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease—an evidence-based guideline. Nat Rev Cardiol 9, 297–309 (2012). https://doi.org/10.1038/nrcardio.2012.7

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