Echocardiography for Diagnosis and Management of Rheumatic Fever

Lg, Veasy

doi:10.1001/jama.1993.03500160050017

Cited by 8 publications

(4 citation statements)

References 3 publications

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“…7 However, our findings confirm previous reports that Doppler echocardiography can detect significant valvar incompetence in the absence of auscultatory findings, during both the acute and the quiescent phases of the disease 34 7 17 18 In the well known recent outbreak of rheumatic fever in the USA, carditis was diagnosed by auscultation in 53 of the 74 patients (72%), while Doppler echocardiography detected mitral regurgitation in an additional 14 patients (19%) 19. The same group also detected subclinical carditis in 47% of rheumatic fever patients presenting with polyarthritis and 57% of patients with “pure” chorea,7 as we did in 50% of our own cases with no clinical evidence of rheumatic heart disease.…”

Section: Discussionsupporting

confidence: 88%

Prospective comparison of clinical and echocardiographic diagnosis of rheumatic carditis: long term follow up of patients with subclinical disease

Figueroa

Fernández

Valdés

et al. 2001

Heart

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Objective-To determine the frequency of occurrence and long term evolution of subclinical carditis in patients with acute rheumatic fever. Design-Valvar incompetence was detected by clinical examination and Doppler echocardiographic imaging during the acute and quiescent phases of rheumatic fever. Patients were followed prospectively and submitted to repeat examinations at one and five years after the acute attack. Persistence of acute mitral and aortic lesions detected solely by echocardiography (subclinical disease) was compared with that of disease detected by clinical examination as well (thereby fulfilling the latest 1992 Jones criteria for rheumatic carditis). Setting-Three general hospitals with a university aYliation in Chile. Patients-35 consecutive patients fulfilling the revised Jones criteria for rheumatic fever. Clinical and echocardiographic examination was repeated in 32 patients after one year and in 17 after five years. Ten patients had subclinical carditis on admission, six of whom were followed for five years. Main outcome measures-Auscultatory and echocardiographic evidence of mitral or aortic regurgitation during the acute attack or at follow up. Results-Mitral or aortic regurgitation was detected by Doppler echocardiographic imaging in 25/35 rheumatic fever patients as opposed to 5/35 by clinical examination (p = 0.03). Doppler echocardiography revealed acute valvar lesions in 10 of 20 rheumatic fever patients who had no auscultatory evidence of rheumatic carditis (subclinical carditis). Three of these subclinical lesions and three of the clinical or auscultatory lesions detected on admission were still present after five years of follow up, emphasising that subclinical lesions are not necessarily transient. Conclusions-Doppler echocardiographic imaging improves the detection of rheumatic carditis. Subclinical valve lesions, detected only by Doppler imaging, can persist. Echocardiographic findings should be accepted as a major criterion for the diagnosis of rheumatic fever. (Heart 2001;85:407-410)

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Section: Discussionsupporting

confidence: 88%

Prospective comparison of clinical and echocardiographic diagnosis of rheumatic carditis: long term follow up of patients with subclinical disease

Figueroa

Fernández

Valdés

et al. 2001

Heart

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“…Most cases of rheumatic carditis are not severe enough to be symptomatic, and the diagnosis of isolated carditis has previously depended on auscultation alone [53,54,63,64]. Approximately 80% or more of the cases of mitral regurgitation detected by EC are also readily diagnosed by the auscultation of experienced clinicians.…”

Section: Problematic Isolated Major Manifestationsmentioning

confidence: 99%

“…In any case, it is doubtful that a diagnostic tool that is as powerful as EC will be neglected in the assessment of valvular disease wherever the instrument is available and certainly where its expense may not be too great a concern. In my view, whether or not subascultatory mitral regurgitation can be accepted as the sole criterion of carditis in the absence of other major manifestations of RF remains at issue and is certainly dependent on the experience of the examining cardiologist, not only with the technique of EC, but also with the diagnostic criteria of RF [53,63,64]. Whether the Jones criteria should be modified to incorporate these techniques is being debated with differences of opinion tempered by considerations of availability and costbenefit of EC to developing countries, since outcomes of the treatment and management of such minimal valvular inflammation may not differ significantly, whether they are detected or not (see "Therapy") [53].…”

Section: Problematic Isolated Major Manifestationsmentioning

confidence: 99%

Rheumatic Fever in the 21st Century

Stollerman

2001

CLIN INFECT DIS

139

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In the first half of the twentieth century, the group A streptococcus (GAS) was established as the sole etiologic agent of acute rheumatic fever (ARF). In the century's latter half, the clinical importance of variation in the virulence of strains of GAS has become clearer. Although still obscure, the pathogenesis of ARF requires primary infection of the throat by highly virulent GAS strains. These contain very large hyaluronate capsules and M protein molecules. The latter contain epitopes that are cross-reactive with host tissues and also contain superantigenic toxic moieties. In settings where ARF has become rare, GAS pharyngitis continues to be common, although it is caused by GAS strains of relatively lower virulence. These strains, however, colonize the throat avidly and stubbornly. Molecularly distinct pyoderma strains may cause acute glomerulonephritis, but they are not rheumatogenic, even though they may secondarily colonize and infect the throat. Guidelines for the diagnosis, treatment, and prevention of GAS pharyngitis and ARF are reviewed with particular reference to the prevalence of the latter in the community.

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“…5 Few studies using the technique to quantify mitral and aortic valvar regurgitation, however, have been performed better to define its specificity and predictive values. 3,6 Minich et al 6 used the technique to study a group of 68 infants and young adults with cardiac murmurs, 37 patients with rheumatic fever and 31 patients with innocent murmurs, who showed signs of mitral regurgitation. Pathological mitral regurgitation was defined by analysis of a specific set of quantitative and qualitative parameters.…”

mentioning

confidence: 99%