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The case for utilizing more strict quantitative Doppler echocardiographic criterions for diagnosis of subclinical rheumatic carditis

Published online by Cambridge University Press:  22 December 2006

Alvaro M. Caldas ,
Maria Teresa R.A. Terreri ,
Valdir A. Moises ,
Celia M.C. Silva ,
Antonio C. Carvalho  and
Maria Odete E. Hilário
Alvaro M. Caldas
Affiliation:
Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo – SP, Brazil
Maria Teresa R.A. Terreri
Affiliation:
Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo – SP, Brazil
Valdir A. Moises
Affiliation:
Division of Pediatric Cardiology, Discipline of Cardiology, Department of Medicine, Universidade Federal de São Paulo, São Paulo – SP, Brazil
Celia M.C. Silva
Affiliation:
Division of Pediatric Cardiology, Discipline of Cardiology, Department of Medicine, Universidade Federal de São Paulo, São Paulo – SP, Brazil
Antonio C. Carvalho
Affiliation:
Division of Pediatric Cardiology, Discipline of Cardiology, Department of Medicine, Universidade Federal de São Paulo, São Paulo – SP, Brazil
Maria Odete E. Hilário
Affiliation:
Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo – SP, Brazil
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Abstract

Aim: Our aim was to perform a comparative, quantitative and qualitative, analysis of valvar echocardiographic findings in patients with acute rheumatic fever, with or without clinical manifestations of carditis, as compared to healthy controls. Methods and results: We analyzed cross-sectional Doppler echocardiographic images of 31 patients with acute rheumatic fever diagnosed according to the Jones criterions as modified in 1992. Of 31 patients, 22 presented with clinical carditis, while 9 had subclinical carditis. The patients, and a control group of 20 healthy individuals, underwent cardiac examination and echocardiographic assessment, assessing quantitative and qualitative findings of mitral and aortic valvar abnormalities. The leaflets of the mitral valve were statistically thicker in those with clinical and subclinical carditis when compared to controls (p less than 0.001). We observed a greater frequency of mitral variance, convergence of mitral flow, and aortic regurgitation for those with clinical and subclinical carditis when compared to controls (p less than 0.001, p less than 0.001 and p equal to 0.003, respectively). Patients with clinical and subclinical carditis had more quantitative and qualitative changes in the parameters than did the controls. Conclusion: Echocardiography is a sensitive method to detect valvar abnormalities in patients with acute rheumatic fever and carditis. Additionally, by using regular standardized criterions, abnormalities that lead to a diagnosis of subclinical carditis are found in those patients with acute rheumatic fever in the apparent absence of cardiac involvement.

Keywords

Jones criteriacarditisvalvar regurgitationchildren
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Issue 1 , February 2007 , pp. 42 - 47
Copyright
2007 Cambridge University Press

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