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. 2001 Apr;85(4):407–410. doi: 10.1136/heart.85.4.407

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

F Figueroa 1, M Fernandez 1, P Valdes 1, C Wilson 1, F Lanas 1, F Carrion 1, X Berrios 1, F Valdes 1
PMCID: PMC1729708  PMID: 11250966

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 affiliation 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.


Keywords: rheumatic heart disease; rheumatic fever; echocardiography; carditis

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Figure 1  .

Figure 1  

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Subclinical and clinical valve lesions in rheumatic fever patients at entry (A) and at one year (B) and five years (C) follow up. ARF, acute rheumatic fever; No RHD, no clinical or echocardiographic evidence of rheumatic heart disease.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abernethy M., Bass N., Sharpe N., Grant C., Neutze J., Clarkson P., Greaves S., Lennon D., Snow S., Whalley G. Doppler echocardiography and the early diagnosis of carditis in acute rheumatic fever. Aust N Z J Med. 1994 Oct;24(5):530–535. doi: 10.1111/j.1445-5994.1994.tb01753.x. [DOI] [PubMed] [Google Scholar]
  2. BLAND E. F. Chorea as a manifestation of rheumatic fever: a long-term perspective. Trans Am Clin Climatol Assoc. 1961;73:209–213. [PMC free article] [PubMed] [Google Scholar]
  3. BLAND E. F., DUCKETT JONES T. Rheumatic fever and rheumatic heart disease; a twenty year report on 1000 patients followed since childhood. Circulation. 1951 Dec;4(6):836–843. doi: 10.1161/01.cir.4.6.836. [DOI] [PubMed] [Google Scholar]
  4. Carapetis J. R., Currie B. J. Rheumatic chorea in northern Australia: a clinical and epidemiological study. Arch Dis Child. 1999 Apr;80(4):353–358. doi: 10.1136/adc.80.4.353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Eisenberg M. J. Rheumatic heart disease in the developing world: prevalence, prevention, and control. Eur Heart J. 1993 Jan;14(1):122–128. doi: 10.1093/eurheartj/14.1.122. [DOI] [PubMed] [Google Scholar]
  6. Figueroa F., Berríos X., Gutiérrez M., Carrión F., Goycolea J. P., Riedel I., Jacobelli S. Anticardiolipin antibodies in acute rheumatic fever. J Rheumatol. 1992 Aug;19(8):1175–1180. [PubMed] [Google Scholar]
  7. Folger G. M., Jr, Hajar R., Robida A., Hajar H. A. Occurrence of valvar heart disease in acute rheumatic fever without evident carditis: colour-flow Doppler identification. Br Heart J. 1992 Jun;67(6):434–438. doi: 10.1136/hrt.67.6.434. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Minich L. L., Tani L. Y., Pagotto L. T., Shaddy R. E., Veasy L. G. Doppler echocardiography distinguishes between physiologic and pathologic "silent" mitral regurgitation in patients with rheumatic fever. Clin Cardiol. 1997 Nov;20(11):924–926. doi: 10.1002/clc.4960201105. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Narula J., Chandrasekhar Y., Rahimtoola S. Diagnosis of active rheumatic carditis. The echoes of change. Circulation. 1999 Oct 5;100(14):1576–1581. doi: 10.1161/01.cir.100.14.1576. [DOI] [PubMed] [Google Scholar]
  10. Stollerman G. H. Rheumatic fever. Lancet. 1997 Mar 29;349(9056):935–942. doi: 10.1016/S0140-6736(96)06364-7. [DOI] [PubMed] [Google Scholar]
  11. Vasan R. S., Shrivastava S., Vijayakumar M., Narang R., Lister B. C., Narula J. Echocardiographic evaluation of patients with acute rheumatic fever and rheumatic carditis. Circulation. 1996 Jul 1;94(1):73–82. doi: 10.1161/01.cir.94.1.73. [DOI] [PubMed] [Google Scholar]
  12. Veasy L. G. Echocardiography for diagnosis and management of rheumatic fever. JAMA. 1993 Apr 28;269(16):2084–2084. [PubMed] [Google Scholar]
  13. Veasy L. G., Tani L. Y., Hill H. R. Persistence of acute rheumatic fever in the intermountain area of the United States. J Pediatr. 1994 Jan;124(1):9–16. doi: 10.1016/s0022-3476(94)70247-0. [DOI] [PubMed] [Google Scholar]
  14. Veasy L. G., Wiedmeier S. E., Orsmond G. S., Ruttenberg H. D., Boucek M. M., Roth S. J., Tait V. F., Thompson J. A., Daly J. A., Kaplan E. L. Resurgence of acute rheumatic fever in the intermountain area of the United States. N Engl J Med. 1987 Feb 19;316(8):421–427. doi: 10.1056/NEJM198702193160801. [DOI] [PubMed] [Google Scholar]
  15. Wilson N. J., Neutze J. M. Echocardiographic diagnosis of mitral insufficiency. J Pediatr. 1994 Oct;125(4):673–674. doi: 10.1016/s0022-3476(94)70044-3. [DOI] [PubMed] [Google Scholar]
  16. Wilson N. J., Neutze J. M. Echocardiographic diagnosis of subclinical carditis in acute rheumatic fever. Int J Cardiol. 1995 Jun 2;50(1):1–6. doi: 10.1016/0167-5273(95)02325-q. [DOI] [PubMed] [Google Scholar]

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