M-mode, cross-sectional and color flow Doppler echocardiographic findings in acute rheumatic fever

Abstract

M-mode, cross-sectional and color flow Doppler echocardiography were performed in 28 patients with acute rheumatic fever. The patients were grouped according to the presence or absence of carditis and congestive heart failure. Abnormal echocardiographic findings were found in 25 patients (89%), including five with no carditis. M mode echocardiography showed significant cardiac enlargement in all patients with carditis, and in two patients with no carditis. The myocardial contractility, as based on ejection fraction and fractional shortening, was normal in all patients except one. Prolapse of the leaflets of the mitral valve (57%) and increased echogenicity of the leaflets of the mitral valve (36%) were the most common findings seen on cross-sectional echocardiography. Pericardial effusion was seen in six patients (21%), all with heart failure. Color flow and Doppler echocardiography showed that mitral regurgitation, which was seen in 24 patients (86%), was the most common finding. Aortic regurgitation was found in 17 patients (60%). The presence of congestive heart failure in patients with carditis was related to the severity of the valvar regurgitation and the number of valves involved. Echocardiographic evidence of rheumatic involvement of the heart may be observed even in the absence of clinical signs of carditis.

Estudo comparativo das avaliações clínica e ecocardiográfica Doppler na evolução das lesões valvares em crianças e adolescentes portadores de febre reumática

“…Similarly, among the 258 patients submitted to Doppler echocardiographic examinations in the chronic phase, 190 (73.6%) were diagnosed with valve abnormalities, whereas in 85 (44.7%) patients the clinical examination was normal. Regarding the results of the Doppler echocardiographic study performed in the acute phase with 109 patients, the left ventricular contractile function was slightly affected in just one patient (0.9%), which coincides with the results found by Ty & Ortiz 24 who reported a decrease in the ejection fraction and the shortening fraction in one (3.6%) of the 28 patients evaluated in this phase. The authors attribute this fact to the use of anti-infl ammatory agents and the low sensitivity of these parameters in detecting mild contractile function abnormalities.…”

Subclinical rheumatic valvitis: a long-term follow-up

“…Few authors have used a control group of healthy children for comparison between the characteristics of physiological and pathological valvar jets and a blinded analysis by the Doppler echocardiogram. 3,5,[7][8][9]12,[14][15][16] The identification of the valvar lesion by the Doppler echocardiogram at a time prior to the detection of the murmur by cardiac auscultation, as occurred in one patient in our study, and two in the investigation of Abernethy et al, 11 draws attention to the importance of the serial clinical examination, at weekly or biweekly intervals, during the acute phase of rheumatic fever. Considering that the murmurs can appear late, their absence in the initial phase of the acute episode does not rule out a diagnosis of carditis.…”

“…patients with isolated arthritis or chorea and normal cardiac auscultation, a feature which has been called "subclinical valvitis". [3][4][5][6][7][8][9][10][11][12][13][14][15][16] The high sensitivity of the Doppler echocardiogram has also, however, revealed physiological valvar regurgitation in healthy children without any evidence of heart disease, with different characteristics from the regurgitant jets of rheumatic patients with valvar lesions. As a consequence, strict criterions must be used when differentiating these two conditions.…”

The logic for extending the use of echocardiography beyond childhood to detect subclinical rheumatic heart disease

“…For example, of 45 patients with pure chorea, two-thirds had silent mitral regurgitation, as did almost half of a cohort with isolated polyarthritis. 12 Similar experience reported from around the world where rheumatic fever is endemic [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] made us even more secure in our decision. The World Health Organization has now proposed criterions for echocardiographic and Doppler interrogation that more precisely define subclinical mitral regurgitation.…”