Background:Echocardiographic screening can detect asymptomatic cases of rheumatic heart disease (RHD), facilitating access to treatment. Barriers to implementation of echocardiographic screening include the requirement for expensive equipment and expert practitioners. We aimed to evaluate the diagnostic accuracy of an abbreviated echocardiographic screening protocol (single parasternal-long-axis view with a sweep of the heart) performed by briefly trained, nonexpert practitioners using handheld ultrasound devices.Methods:Participants aged 5 to 20 years in Timor-Leste and the Northern Territory of Australia had 2 echocardiograms: one performed by an expert echocardiographer using a GE Vivid I or Vivid Q portable ultrasound device (reference test), and one performed by a nonexpert practitioner using a GE Vscan handheld ultrasound device (index test). The accuracy of the index test, compared with the reference test, for identifying cases with definite or borderline RHD was determined.Results:There were 3111 enrolled participants; 2573 had both an index test and reference test. Median age was 12 years (interquartile range, 10–15); 58.2% were female. Proportion with definite or borderline RHD was 5.52% (95% CI, 4.70–6.47); proportion with definite RHD was 3.23% (95% CI, 2.61–3.98).Compared with the reference test, sensitivity of the index test for definite or borderline RHD was 70.4% (95% CI, 62.2–77.8), specificity was 78.1% (95% CI, 76.4–79.8).Conclusions:Nonexpert practitioners can be trained to perform single parasternal-long-axis view with a sweep of the heart echocardiography. However, the specificity and sensitivity are inadequate for echocardiographic screening. Improved training for nonexpert practitioners should be investigated.

中文翻译：

---

非专家从业者的单视图超声心动图检测风湿性心脏病：诊断准确性的前瞻性研究

背景：超声心动图筛查可以检测无症状的风湿性心脏病 (RHD) 病例，从而促进治疗。实施超声心动图筛查的障碍包括需要昂贵的设备和专业从业人员。我们的目的是评估简短的超声心动图筛查方案（单胸骨旁长轴视图与心脏扫描）的诊断准确性，该方案由经过简单培训的非专业从业者使用手持超声设备进行。方法：帝汶 5 至 20 岁的参与者- 莱斯特和澳大利亚北领地有 2 次超声心动图：一次由专家超声心动图师使用 GE Vivid I 或 Vivid Q 便携式超声设备执行（参考测试），另一次由非专家医生使用 GE Vscan 手持超声设备执行（索引测试）。确定指标测试与参考测试相比，用于识别确诊或边缘 RHD 病例的准确性。结果：共有 3111 名参与者；2573 有指数测试和参考测试。中位年龄为 12 岁（四分位距，10-15）；58.2% 是女性。明确或临界 RHD 的比例为 5.52%（95% CI，4.70–6.47）；确定 RHD 的比例为 3.23%（95% CI，2.61-3.98）。与参考试验相比，确定或临界 RHD 指标试验的敏感性为 70.4%（95% CI，62.2-77.8），特异性为 78.1% (95% CI, 76.4–79.8)。结论：可以训练非专业从业者通过心脏超声心动图扫描执行单一的胸骨旁长轴切面。然而，超声心动图筛查的特异性和敏感性不足。