Cardiology in the Young

Table of Contents - 2007 - Volume 17, Issue 01  


Original Article

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

Alvaro M. Caldas a1, Maria Teresa R.A. Terreri a1c1, Valdir A. Moises a2, Celia M.C. Silva a2, Antonio C. Carvalho a2 and Maria Odete E. Hilário a1
a1 Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo – SP, Brazil
a2 Division of Pediatric Cardiology, Discipline of Cardiology, Department of Medicine, Universidade Federal de São Paulo, São Paulo – SP, Brazil

Article author query
caldas am   [PubMed][Google Scholar] 
terreri mt   [PubMed][Google Scholar] 
moises va   [PubMed][Google Scholar] 
silva cm   [PubMed][Google Scholar] 
carvalho ac   [PubMed][Google Scholar] 
hilario mo   [PubMed][Google Scholar] 

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.

(Accepted March 22 2006)


Key Words: Jones criteria; carditis; valvar regurgitation; children.

Correspondence:
c1 Correspondence to: Maria Teresa R.A. Terreri, Rua, Loefgreen 2381, apt 141 Cep: 04040-004 São Paulo – SP, Brazil. Tel/Fax: +55 11 5579 1590; E-mail: terreri@uninet.com.br

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