Predictors of Chronic Valvular Disease in Patients With Rheumatic Carditis

Abstract

This study investigated the predictors of chronic valvular disease in children with rheumatic carditis. The short- to mid-term follow-up records of 88 patients (mean age, 10.68 ± 2.5 years) with chronic rheumatic heart disease were reviewed. The mean follow-up period was 2.95 ± 1.4 years. Valvular involvement completely improved for 24 of the patients (27%) during the follow-up period. The multivariate logistic regression analysis found initial left ventricular dilation to be a significant independent risk factor associated with the persistence of either valvular involvement or mitral regurgitation. Furthermore, persistence of mitral regurgitation was found to be strongly correlated with cardiac murmur at admission. No significant correlation was detected between age, gender, severity of valvular involvements at initial evaluation, and chronic valvular disease. The majority of patients with rheumatic carditis had normal left ventricular systolic function. However, a significant proportion of patients had left ventricular dilation, reported in the medical literature to be associated with the severity of valve involvement. This study found no relation between initial severity of valve involvements and chronic valvular disease. For this reason, increased left ventricular end-diastolic diameter may be secondary to myocardial involvement independent of valvular regurgitation. The findings in this study also suggest that subclinic carditis had a better outcome than clinically evident carditis.

Ventricular dyssynchrony as a marker of latent carditis in children with acute rheumatic fever: A tissue Doppler imaging

“…Moreover, the QT dispersion to be greater, with greater valvular pathology, providing an evidence of electrophysiological changes. 25,26 There is no study concerning LV dyssynchrony, in children with ARF; however, in the current study, when comparing the Ts-SD-12 in patient with and without basal valvular regurgitation, the LV dyssynchrony was comparable, reflecting an independent association with valvular pathology.…”

“…With considering a Ts-SD-12 ≥ 31.4 ms, 12 as the cutoff value of LV systolic dyssynchrony, a significant number of children (22, 45.8%) with acute rheumatic arthritis only (group I) (group I) had left ventricular systolic dyssynchrony, while (26,63.4%) children with carditis (group II) had LV dyssynchrony, (P > .05). Table 2 represents the LV systolic dyssynchrony parameters in children with arthritis only and those with carditis in comparison with controls.…”

“…A previous study proposed that QT dispersion increases in association with cardiac involvement in patients with ARF. Moreover, the QT dispersion to be greater, with greater valvular pathology, providing an evidence of electrophysiological changes …”

Prognostic value of clinical and Doppler echocardiographic findings in children and adolescents with significant rheumatic valvular disease

“…In a recent study, Yilmazer et al . [25] investigated predictive factors of valvular heart disease in 88 patients with rheumatic carditis followed-up for a period of 2.95 ± 1.4 years and, according to a logistic regression multivariate analysis, they observed that ventricular dilatation was an independent risk factor associated with persistence of mitral valve disease. They did not find a correlation with severity of valvular involvement in the initial assessment, and concluded that their findings could have resulted from myocardial involvement and not from severity of valvulitis.…”

Difficulties in the Diagnosis of Acute Rheumatic Fever without Carditis, Karditsiz Akut Romatizmal Ateş Tanısında Zorluklar

“…The mean age of patients at the first attack is 8 years (range, 5-15 years), and attacks are rarely seen <5 years (2)(3)(4)(5). It occurs more often in winter and spring in regions with a temperate climate, and without gender or race differentiation (6). It can be seen after a 2-5 week latent period following streptococcal pharyngitis.…”