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

Abstract

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)

Clinical Evaluation Versus Echocardiography in the Assessment of Rheumatic Heart Disease

“…Invention of the echocardiogram by Edler et al in 1951 changed this. It has been seen in many studies that the echo is much more sensitive in picking up the lesions which are easily missed on clinical examination [3][4][5][6][7][8][9].…”

“…The role of echocardiogram in detecting heart lesions in acute rheumatic fever has been controversial. On one hand, some researchers [8][9][10] Material and Methods 50 consecutive cases of RHD admitted to a large teaching hospital and out patient cases seen between March 2001 to August 2001 formed the material for the present study. All the patients were in the paediatric age group between 5 to 16 years.…”

Feasibility study of first-year medical students identifying cardiac anatomy using ultrasound in rural Panama

“…Additionally, the ability of minimally trained medical students to identify cardiac pathology is not well understood. [6,11] Our aim was to determine if minimally trained first-year medical students were able to identify basic cardiac anatomy. The development of basic ultrasound curriculum initiated early in medical education allows minimally trained practitioners early exposure to ultrasonography.…”

“…[2] With advanced imaging often financially out of reach for many in these populations, ultrasound has emerged as a convenient and portable method of imaging in rural communities and austere environments. [3][4][5][6] Furthermore, f o r t h e d i a g n o s i s o f c o n g e n i t a l h e a r t d i s e a s e , echocardiography has become a first-line imaging modality. [7] Since 2006, both the National Institutes of Health (NIH) and WHO have promoted guidelines for both screening and diagnosis of congenital cardiac anomalies.…”

Epidemiology of valvular heart diseases in Africa

“…(2) However, the counter argument for the use of echocardiographic screening and diagnosing of RHD in high prevalent settings is being correctly advanced by some. (2,17,53,54) Echocardiography is superior to physical examination in diagnosing valve disease and it makes sense to try to fi nd models and establish guidelines for proper application of echocardiography for the sake of determining true incidence and prevalence of disease and to identify cases needing secondary prophylaxis. (7,17) PREVENTION AND MANAGEMENT OF…”