Joselyn Rwebembera - Academia.edu (original) (raw)

Papers by Joselyn Rwebembera

˜The œannals of thoracic surgery, Jun 1, 2024

Journal of the American College of Cardiology, Apr 1, 2024

Heart rhythm O2, Feb 1, 2024

Global heart, Dec 31, 2022

Background: Chronic valvular heart disease is a well-known, long-term complication of acute rheum... more Background: Chronic valvular heart disease is a well-known, long-term complication of acute rheumatic fever (ARF), which remains a major public health problem in low-and middle-income countries. Access to surgical management remains limited. Outcomes of the minority proportion of patients that access surgery have not been described in Uganda. Objectives: To describe the volume and type of rheumatic heart disease (RHD) valvular interventions and the outcomes of operated patients in the Uganda RHD registry. Methods: We performed a retrospective cohort study of all valve surgery procedures identified in the Uganda RHD registry through December 2021. Results: Three hundred and sixty-seven surgical procedures were performed among 359 patients. More than half were among young (55.9% were ≤20 years of age), female (59.9%) patients. All patients were censored at 15 years. The median (IQR) follow up period was 43 (22,79) months. Nearly half of surgeries (46.9%) included interventions on multiple valves, and most valvular operations were replacements with mechanical prostheses (96.6%). Over 70% of the procedures were sponsored by charity organizations. The overall mortality of patients who underwent surgery was 13% (47/359), with over half of the mortalities occurring within the first year following surgery (27/47; 57.4%). Fifteenyear survival or freedom from re-operation was not significantly different between those receiving valve replacements and those receiving valve repair (log-rank p = 0.76). Conclusions: There has been increasing access to valve surgery among Ugandan patients with RHD. Post-operative survival is similar to regionally reported rates. The growing cohort of patients living with prosthetic valves necessitates national expansion and decentralization of post-operative care services. Major reliance on charity funding of surgery is unsustainable, thus calling for locally generated and controlled support mechanisms such as a national health insurance scheme. The central illustration (Figure 1) provides a summary of our findings and recommendations. 3 Rwebembera et al.

BMJ Open, Sep 30, 2023

Evaluating the implementation of a dynamic digital application to enable communitybased decentral... more Evaluating the implementation of a dynamic digital application to enable communitybased decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study.

Nature reviews. Cardiology, Mar 26, 2024

In the version of the article initially published, the surname of Giulia Magnani was misspelt as ... more In the version of the article initially published, the surname of Giulia Magnani was misspelt as Magniani. This has now been corrected in the HTML and PDF versions of the article.

Nature Reviews Cardiology

Circulation, Nov 8, 2022

Introduction: Rheumatic heart disease (RHD) is the number one cause globally of morbidity and mor... more Introduction: Rheumatic heart disease (RHD) is the number one cause globally of morbidity and mortality from heart disease in children and young adults. The mitral regurgitation (MR) jet length on color Doppler echocardiography is an important index for diagnosis, but its measurement and interpretation vary. Objective: Develop an automatic machine learning approach to identify and measure the MR jet length on color Doppler for RHD detection. Methods: We used 316 echocardiograms from 95 children (mean age 12±2 years; range 5 to 17 years) with DICOM color Doppler images of the mitral valve taken from parasternal long axis (PLAX) and apical 4 chamber (AP4) views. All echocardiograms were independently reviewed by an adjudication panel consisting of four expert pediatric cardiologists to determine maximum MR jet length and diagnosis (RHD or normal). Among 95 cases, 29 were normal and 66 had RHD. Our automated method included. (1) Selection of frames during ventricular systole using a convolutional neural network architecture. (2) Localization of left atrium using convolutional neural networks with LinkNet structure. (3) Measurement of MR jet length by image color analysis. (4) Detection of RHD by applying a generalized regression model based on the maximum MR jet length measured and maximizing the balanced accuracy using cross validation. Results: Machine learning selected the correct systolic frame with an average accuracy of 0.95 (sensitivity 97%/specificity 93%) and 0.94 (sensitivity 94%/specificity 94%) for the AP4 and PLAX view, respectively. It localized the atrium with an average Dice coefficient of 0.89 and 0.9 for the AP4 and PLAX view, respectively. We estimated the MR jet length with an average absolute error of 0.33±0.4 cm (p-value = 0.15 compared to manual measurements). Our deep learning approach performed similar to or better than previously published manual methods for categorization of RHD positive vs negative. The accuracy of RHD detection was 0.84 (sensitivity 86%/specificity 79%). Conclusions: Our automatic method has the potential to reliably detect RHD as accurately as expert cardiologists. This innovative approach holds promise to scale echocardiography screening for RHD and expand prophylaxis to prevent progression of RHD globally.

Circulation, Nov 8, 2022

Background: Secondary antibiotic prophylaxis reduces progression in children with latent rheumati... more Background: Secondary antibiotic prophylaxis reduces progression in children with latent rheumatic heart disease (RHD). However, nearly half of children show improvement with or without prophylaxis. Improved risk stratification could refine prophylaxis recommendations following positive screening echo. We aimed to validate a previously developed echo risk score to predict mid-term RHD outcomes among children with latent RHD. Methods: Our population included children who completed the GOAL Trial, a randomized controlled trial of secondary antibiotic prophylaxis among children with latent RHD in Uganda. These children underwent echo at enrollment and study completion, with rigorous blinded adjudication by a 4-member panel to establish diagnosis. We applied a point-based risk score developed from prior Brazilian and Ugandan cohorts, consisting of 5 variables (mitral valve (MV) anterior leaflet thickening (3 points), MV excessive leaflet tip motion (3), MV regurgitation jet length ≥2 cm (6), aortic valve focal thickening (4) and any aortic regurgitation (5)) to predict unfavorable outcome, defined as progression of diagnostic category (borderline to definite, definite mild valvular disease to definite moderate/severe disease) or remaining with definite RHD. Results: At total 801 patients (626 borderline and 175 definite RHD, mean age 12.5±2.9 years) were included, with median follow-up of 24 months. RHD progression was observed in 3 patients in the Penicillin group, vs. 33 in the control group, and overall, 386 patients regressed and 377 remained stable. The echo score was strongly associated with unfavorable outcome (OR: 1.25, 95% CI 1.15 - 1.36, p<0.001). Unfavorable outcome rates in low (≤6 points), intermediate (7 - 9) and high-risk (≥10) children at follow-up were 12.2%, 31.1%, and 42.2%, (p<0.001) respectively, with area under the ROC curve of 0.64 (95% CI 0.59 - 0.69). Among children without prophylaxis, the score had a similarly good performance: OR: 1.24 (95% CI 1.12 - 1.39), area under the ROC curve: 0.64 (95% CI 0.58 - 0.70). Conclusions: The simple risk score provided an accurate prediction of RHD status at 2-years, showing a good performance in a population with milder RHD phenotypes, with a potential value for global risk stratification.

Circulation, Nov 8, 2022

Introduction: Secondary antibiotic prophylaxis improves outcomes for children diagnosed with late... more Introduction: Secondary antibiotic prophylaxis improves outcomes for children diagnosed with latent rheumatic heart disease (RHD). However, many children with latent RHD show improvement without prescription of prophylaxis. The objective of this study was to determine if specific sociodemographic or echocardiographic features are associated with progression of latent RHD. Methods: This is a retrospective analysis of the GOAL Trial, a randomized controlled trial of secondary antibiotic prophylaxis in children with latent RHD conducted in Uganda. Sociodemographic and echocardiographic variables were collected at trial entry. Progression was defined by a change in echocardiographic category according to the World Heart Federation Criteria (WHF; normal, borderline RHD, mild definite RHD, moderate/severe RHD), determined by consensus of a blinded 4-member adjudication panel. The association of risk factors with progression were calculated as odds ratios (OR) with 95% confidence intervals (CI) using logistic regression models adjusted for the randomized treatment arm and the stratification variable (definite/borderline RHD). Results: Outcomes for the 799 children who completed the GOAL Trial were included in this analysis. Female sex (OR 2.6, 95% CI 1.19-5.68, p=0.016) and poorer socioeconomic conditions (WAMI Index 0-1 with 1 being the least deprived, OR 0.48 for every 0.10-point increase) were associated with progression. There was no difference in risk of progression or regression between those with borderline RHD or mild definite RHD. Conclusions: Females and those living in less advantaged conditions were more likely to show progression of latent RHD. The strength of these associations was relatively low and does not warrant restricting prophylaxis to subgroups based on risk factors. The lack of difference in progression risk between those with borderline and those with definite RHD may impact revisions of the World Heart Federation Criteria for latent RHD diagnosis and calls into question the use of the term ‘borderline RHD’.

Circulation, Jun 13, 2023

Open heart, Dec 1, 2022

Background Screening programmes using echocardiography offer opportunity for intervention through... more Background Screening programmes using echocardiography offer opportunity for intervention through identification and treatment of early (latent) rheumatic heart disease (RHD). We aimed to compare two methods for classifying progression or regression of latent RHD: serial review method and blinded, side-by-side review. Methods A four-member expert panel reviewed 799 enrolment (in 2018) and completion (in 2020) echocardiograms from the GOAL Trial of latent RHD in Uganda to make consensus determination of normal, borderline RHD or definite RHD. Serial interpretations (enrolment and completion echocardiograms read at two different time points, 2 years apart, not beside one another) were compared with blinded side-by-side comparisons (enrolment and completion echocardiograms displayed beside one another in random order on same screen) to determine outcomes according to prespecified definitions of disease progression (worsening), regression (improving) or no change. We calculated inter-rater agreement using Cohen's kappa. Results There were 799 pairs of echocardiogram assessments included. A higher number, 54 vs 38 (6.8% vs 4.5%), were deemed as progression by serial interpretation compared with side-by-side comparison. There was good inter-rater agreement between the serial interpretation and side-by-side comparison methods (kappa 0.89). Disagreement was most often a result of the difference in classification between borderline RHD and mild definite RHD. Most discrepancies between interpretation methods (46 of 47, 98%) resulted from differences in valvular morphological evaluation, with valves judged to be morphologically similar between enrolment and final echocardiograms when compared side by side but classified differently on serial interpretation. Conclusions There was good agreement between the methods of serial and side-by-side interpretation of echocardiograms for change over time, using the World Heart Federation criteria. Side-by-side interpretation has higher specificity for change, with fewer differences in the interpretation of valvular morphology, as compared with serial interpretation.

Circulation, Nov 16, 2021

Introduction: Rheumatic heart disease affects 40.5 million people globally and causes 306,000 ann... more Introduction: Rheumatic heart disease affects 40.5 million people globally and causes 306,000 annual deaths. Echocardiographic screening detects rheumatic heart disease at an early, latent stage. However, it is unknown if secondary antibiotic prophylaxis is effective at preventing progression of latent rheumatic heart disease. Methods: We conducted a randomized controlled trial of secondary antibiotic prophylaxis among Ugandan children (5-17 years) with latent rheumatic heart disease. We randomized children to receive either 4-weekly injections of benzathine benzylpenicillin G or no prophylaxis. All children underwent echocardiography at baseline and 2 years after randomization. Changes from baseline were adjudicated by a panel blinded to treatment allocation. The primary outcome was rheumatic heart disease progression. The trial was registered at ClinicalTrials.org (NCT03346525) on November 17, 2017. Results: 818 were included in the modified intention to treat analysis and 799 participants (97.7%) reached study completion. Three participants in the prophylaxis group (0.8%) demonstrated echocardiographic progression, compared to 33 (8.3%) in the control group (risk difference -7.5%, 95%CI, -10.2 to -4.7, p<0.001). The number of children with latent rheumatic heart disease needed to receive prophylaxis to prevent one child from developing progression was 13 (95%CI, 10 to 21). There were 2 serious adverse events in the prophylaxis group, including one episode of a mild anaphylactic reaction (0.01% of all treatment doses). Conclusions: Secondary antibiotic prophylaxis reduces the risk of latent rheumatic heart disease progression at 2 years. These data provide new information for our understanding of the role of screening for latent rheumatic heart disease. Further research is needed before the implementation of population-level screening can be recommended.

Circulation, Nov 19, 2019

Journal of the American Society of Echocardiography

Open Heart

BackgroundScreening programmes using echocardiography offer opportunity for intervention through ... more BackgroundScreening programmes using echocardiography offer opportunity for intervention through identification and treatment of early (latent) rheumatic heart disease (RHD). We aimed to compare two methods for classifying progression or regression of latent RHD: serial review method and blinded, side-by-side review.MethodsA four-member expert panel reviewed 799 enrolment (in 2018) and completion (in 2020) echocardiograms from the GOAL Trial of latent RHD in Uganda to make consensus determination of normal, borderline RHD or definite RHD. Serial interpretations (enrolment and completion echocardiograms read at two different time points, 2 years apart, not beside one another) were compared with blinded side-by-side comparisons (enrolment and completion echocardiograms displayed beside one another in random order on same screen) to determine outcomes according to prespecified definitions of disease progression (worsening), regression (improving) or no change. We calculated inter-rater...

˜The œannals of thoracic surgery, Jun 1, 2024

Journal of the American College of Cardiology, Apr 1, 2024

Heart rhythm O2, Feb 1, 2024

Global heart, Dec 31, 2022

Background: Chronic valvular heart disease is a well-known, long-term complication of acute rheum... more Background: Chronic valvular heart disease is a well-known, long-term complication of acute rheumatic fever (ARF), which remains a major public health problem in low-and middle-income countries. Access to surgical management remains limited. Outcomes of the minority proportion of patients that access surgery have not been described in Uganda. Objectives: To describe the volume and type of rheumatic heart disease (RHD) valvular interventions and the outcomes of operated patients in the Uganda RHD registry. Methods: We performed a retrospective cohort study of all valve surgery procedures identified in the Uganda RHD registry through December 2021. Results: Three hundred and sixty-seven surgical procedures were performed among 359 patients. More than half were among young (55.9% were ≤20 years of age), female (59.9%) patients. All patients were censored at 15 years. The median (IQR) follow up period was 43 (22,79) months. Nearly half of surgeries (46.9%) included interventions on multiple valves, and most valvular operations were replacements with mechanical prostheses (96.6%). Over 70% of the procedures were sponsored by charity organizations. The overall mortality of patients who underwent surgery was 13% (47/359), with over half of the mortalities occurring within the first year following surgery (27/47; 57.4%). Fifteenyear survival or freedom from re-operation was not significantly different between those receiving valve replacements and those receiving valve repair (log-rank p = 0.76). Conclusions: There has been increasing access to valve surgery among Ugandan patients with RHD. Post-operative survival is similar to regionally reported rates. The growing cohort of patients living with prosthetic valves necessitates national expansion and decentralization of post-operative care services. Major reliance on charity funding of surgery is unsustainable, thus calling for locally generated and controlled support mechanisms such as a national health insurance scheme. The central illustration (Figure 1) provides a summary of our findings and recommendations. 3 Rwebembera et al.

BMJ Open, Sep 30, 2023

Evaluating the implementation of a dynamic digital application to enable communitybased decentral... more Evaluating the implementation of a dynamic digital application to enable communitybased decentralisation of rheumatic heart disease case management in Uganda: protocol for a hybrid type III effectiveness-implementation study.

Nature reviews. Cardiology, Mar 26, 2024

In the version of the article initially published, the surname of Giulia Magnani was misspelt as ... more In the version of the article initially published, the surname of Giulia Magnani was misspelt as Magniani. This has now been corrected in the HTML and PDF versions of the article.

Nature Reviews Cardiology

Circulation, Nov 8, 2022

Introduction: Rheumatic heart disease (RHD) is the number one cause globally of morbidity and mor... more Introduction: Rheumatic heart disease (RHD) is the number one cause globally of morbidity and mortality from heart disease in children and young adults. The mitral regurgitation (MR) jet length on color Doppler echocardiography is an important index for diagnosis, but its measurement and interpretation vary. Objective: Develop an automatic machine learning approach to identify and measure the MR jet length on color Doppler for RHD detection. Methods: We used 316 echocardiograms from 95 children (mean age 12±2 years; range 5 to 17 years) with DICOM color Doppler images of the mitral valve taken from parasternal long axis (PLAX) and apical 4 chamber (AP4) views. All echocardiograms were independently reviewed by an adjudication panel consisting of four expert pediatric cardiologists to determine maximum MR jet length and diagnosis (RHD or normal). Among 95 cases, 29 were normal and 66 had RHD. Our automated method included. (1) Selection of frames during ventricular systole using a convolutional neural network architecture. (2) Localization of left atrium using convolutional neural networks with LinkNet structure. (3) Measurement of MR jet length by image color analysis. (4) Detection of RHD by applying a generalized regression model based on the maximum MR jet length measured and maximizing the balanced accuracy using cross validation. Results: Machine learning selected the correct systolic frame with an average accuracy of 0.95 (sensitivity 97%/specificity 93%) and 0.94 (sensitivity 94%/specificity 94%) for the AP4 and PLAX view, respectively. It localized the atrium with an average Dice coefficient of 0.89 and 0.9 for the AP4 and PLAX view, respectively. We estimated the MR jet length with an average absolute error of 0.33±0.4 cm (p-value = 0.15 compared to manual measurements). Our deep learning approach performed similar to or better than previously published manual methods for categorization of RHD positive vs negative. The accuracy of RHD detection was 0.84 (sensitivity 86%/specificity 79%). Conclusions: Our automatic method has the potential to reliably detect RHD as accurately as expert cardiologists. This innovative approach holds promise to scale echocardiography screening for RHD and expand prophylaxis to prevent progression of RHD globally.

Circulation, Nov 8, 2022

Background: Secondary antibiotic prophylaxis reduces progression in children with latent rheumati... more Background: Secondary antibiotic prophylaxis reduces progression in children with latent rheumatic heart disease (RHD). However, nearly half of children show improvement with or without prophylaxis. Improved risk stratification could refine prophylaxis recommendations following positive screening echo. We aimed to validate a previously developed echo risk score to predict mid-term RHD outcomes among children with latent RHD. Methods: Our population included children who completed the GOAL Trial, a randomized controlled trial of secondary antibiotic prophylaxis among children with latent RHD in Uganda. These children underwent echo at enrollment and study completion, with rigorous blinded adjudication by a 4-member panel to establish diagnosis. We applied a point-based risk score developed from prior Brazilian and Ugandan cohorts, consisting of 5 variables (mitral valve (MV) anterior leaflet thickening (3 points), MV excessive leaflet tip motion (3), MV regurgitation jet length ≥2 cm (6), aortic valve focal thickening (4) and any aortic regurgitation (5)) to predict unfavorable outcome, defined as progression of diagnostic category (borderline to definite, definite mild valvular disease to definite moderate/severe disease) or remaining with definite RHD. Results: At total 801 patients (626 borderline and 175 definite RHD, mean age 12.5±2.9 years) were included, with median follow-up of 24 months. RHD progression was observed in 3 patients in the Penicillin group, vs. 33 in the control group, and overall, 386 patients regressed and 377 remained stable. The echo score was strongly associated with unfavorable outcome (OR: 1.25, 95% CI 1.15 - 1.36, p<0.001). Unfavorable outcome rates in low (≤6 points), intermediate (7 - 9) and high-risk (≥10) children at follow-up were 12.2%, 31.1%, and 42.2%, (p<0.001) respectively, with area under the ROC curve of 0.64 (95% CI 0.59 - 0.69). Among children without prophylaxis, the score had a similarly good performance: OR: 1.24 (95% CI 1.12 - 1.39), area under the ROC curve: 0.64 (95% CI 0.58 - 0.70). Conclusions: The simple risk score provided an accurate prediction of RHD status at 2-years, showing a good performance in a population with milder RHD phenotypes, with a potential value for global risk stratification.

Circulation, Nov 8, 2022

Introduction: Secondary antibiotic prophylaxis improves outcomes for children diagnosed with late... more Introduction: Secondary antibiotic prophylaxis improves outcomes for children diagnosed with latent rheumatic heart disease (RHD). However, many children with latent RHD show improvement without prescription of prophylaxis. The objective of this study was to determine if specific sociodemographic or echocardiographic features are associated with progression of latent RHD. Methods: This is a retrospective analysis of the GOAL Trial, a randomized controlled trial of secondary antibiotic prophylaxis in children with latent RHD conducted in Uganda. Sociodemographic and echocardiographic variables were collected at trial entry. Progression was defined by a change in echocardiographic category according to the World Heart Federation Criteria (WHF; normal, borderline RHD, mild definite RHD, moderate/severe RHD), determined by consensus of a blinded 4-member adjudication panel. The association of risk factors with progression were calculated as odds ratios (OR) with 95% confidence intervals (CI) using logistic regression models adjusted for the randomized treatment arm and the stratification variable (definite/borderline RHD). Results: Outcomes for the 799 children who completed the GOAL Trial were included in this analysis. Female sex (OR 2.6, 95% CI 1.19-5.68, p=0.016) and poorer socioeconomic conditions (WAMI Index 0-1 with 1 being the least deprived, OR 0.48 for every 0.10-point increase) were associated with progression. There was no difference in risk of progression or regression between those with borderline RHD or mild definite RHD. Conclusions: Females and those living in less advantaged conditions were more likely to show progression of latent RHD. The strength of these associations was relatively low and does not warrant restricting prophylaxis to subgroups based on risk factors. The lack of difference in progression risk between those with borderline and those with definite RHD may impact revisions of the World Heart Federation Criteria for latent RHD diagnosis and calls into question the use of the term ‘borderline RHD’.

Circulation, Jun 13, 2023

Open heart, Dec 1, 2022

Background Screening programmes using echocardiography offer opportunity for intervention through... more Background Screening programmes using echocardiography offer opportunity for intervention through identification and treatment of early (latent) rheumatic heart disease (RHD). We aimed to compare two methods for classifying progression or regression of latent RHD: serial review method and blinded, side-by-side review. Methods A four-member expert panel reviewed 799 enrolment (in 2018) and completion (in 2020) echocardiograms from the GOAL Trial of latent RHD in Uganda to make consensus determination of normal, borderline RHD or definite RHD. Serial interpretations (enrolment and completion echocardiograms read at two different time points, 2 years apart, not beside one another) were compared with blinded side-by-side comparisons (enrolment and completion echocardiograms displayed beside one another in random order on same screen) to determine outcomes according to prespecified definitions of disease progression (worsening), regression (improving) or no change. We calculated inter-rater agreement using Cohen's kappa. Results There were 799 pairs of echocardiogram assessments included. A higher number, 54 vs 38 (6.8% vs 4.5%), were deemed as progression by serial interpretation compared with side-by-side comparison. There was good inter-rater agreement between the serial interpretation and side-by-side comparison methods (kappa 0.89). Disagreement was most often a result of the difference in classification between borderline RHD and mild definite RHD. Most discrepancies between interpretation methods (46 of 47, 98%) resulted from differences in valvular morphological evaluation, with valves judged to be morphologically similar between enrolment and final echocardiograms when compared side by side but classified differently on serial interpretation. Conclusions There was good agreement between the methods of serial and side-by-side interpretation of echocardiograms for change over time, using the World Heart Federation criteria. Side-by-side interpretation has higher specificity for change, with fewer differences in the interpretation of valvular morphology, as compared with serial interpretation.

Circulation, Nov 16, 2021

Introduction: Rheumatic heart disease affects 40.5 million people globally and causes 306,000 ann... more Introduction: Rheumatic heart disease affects 40.5 million people globally and causes 306,000 annual deaths. Echocardiographic screening detects rheumatic heart disease at an early, latent stage. However, it is unknown if secondary antibiotic prophylaxis is effective at preventing progression of latent rheumatic heart disease. Methods: We conducted a randomized controlled trial of secondary antibiotic prophylaxis among Ugandan children (5-17 years) with latent rheumatic heart disease. We randomized children to receive either 4-weekly injections of benzathine benzylpenicillin G or no prophylaxis. All children underwent echocardiography at baseline and 2 years after randomization. Changes from baseline were adjudicated by a panel blinded to treatment allocation. The primary outcome was rheumatic heart disease progression. The trial was registered at ClinicalTrials.org (NCT03346525) on November 17, 2017. Results: 818 were included in the modified intention to treat analysis and 799 participants (97.7%) reached study completion. Three participants in the prophylaxis group (0.8%) demonstrated echocardiographic progression, compared to 33 (8.3%) in the control group (risk difference -7.5%, 95%CI, -10.2 to -4.7, p<0.001). The number of children with latent rheumatic heart disease needed to receive prophylaxis to prevent one child from developing progression was 13 (95%CI, 10 to 21). There were 2 serious adverse events in the prophylaxis group, including one episode of a mild anaphylactic reaction (0.01% of all treatment doses). Conclusions: Secondary antibiotic prophylaxis reduces the risk of latent rheumatic heart disease progression at 2 years. These data provide new information for our understanding of the role of screening for latent rheumatic heart disease. Further research is needed before the implementation of population-level screening can be recommended.

Circulation, Nov 19, 2019

Journal of the American Society of Echocardiography

Open Heart

BackgroundScreening programmes using echocardiography offer opportunity for intervention through ... more BackgroundScreening programmes using echocardiography offer opportunity for intervention through identification and treatment of early (latent) rheumatic heart disease (RHD). We aimed to compare two methods for classifying progression or regression of latent RHD: serial review method and blinded, side-by-side review.MethodsA four-member expert panel reviewed 799 enrolment (in 2018) and completion (in 2020) echocardiograms from the GOAL Trial of latent RHD in Uganda to make consensus determination of normal, borderline RHD or definite RHD. Serial interpretations (enrolment and completion echocardiograms read at two different time points, 2 years apart, not beside one another) were compared with blinded side-by-side comparisons (enrolment and completion echocardiograms displayed beside one another in random order on same screen) to determine outcomes according to prespecified definitions of disease progression (worsening), regression (improving) or no change. We calculated inter-rater...