Abstract
BackgroundRheumatic heart disease (RHD) complicating acute rheumatic fever (ARF) remains an important health problem in developing countries. No definitive diagnostic test for ARF exists and the role of Doppler echocardiography (DEC) for long-term prognostic evaluation following ARF is not well established.ObjectiveTo investigate the prognostic value of DEC in patients with ARF as a predictor of chronic valve dysfunction.MethodsProspectively enrolled patients with clinical ARF had a DEC performed soon after diagnosis and repeated at 1, 3, 6 and 12 months and thereafter at every 1–2 years. We defined chronic valve dysfunction by ≥ 3 of the following: increased valve thickening, commissure fusion, subvalvular thickening, reduced leaflet mobility, non-trivial mitral and/or aortic regurgitation. We performed univariate analysis and developed multivariate logistic regression models to identify variables that may influence evolution to RHD. p <0.05 was considered significant.ResultsWe evaluated 70(57% men) patients, 10.8±5.6 years-old during the ARF episode and followed for 95±26 months. Chronic valve dysfunction was identified in 36(51.4%) which fulfilled criteria for RHD and 10(27.8%) of them died or underwent valve surgery. Univariate analysis showed that mitral valve thickening and presence of mitral regurgitation at baseline DEC, were associated with RHD(p<0.01). Multivariate logistic regression showed that only mitral valve thickness either as a continuous (Odds-Ratio:5.8;95%CI:1.7–19.7) or as a categorical variable (Odds-Ratio:4.04;95%CI:1.06–15.3) was an independent predictor of chronic valve dysfunction.ConclusionsMitral leaflets thickening documented at the time of diagnosis of ARF is a consistent prognostic marker for the subsequent evolution to RHD.
Highlights
Acute rheumatic fever (ARF) is a systemic inflammatory immunologically mediated complication of a streptococcal upper respiratory infection [1]
We evaluated 70(57% men) patients, 10.8±5.6 years-old during the acute rheumatic fever (ARF) episode and followed for 95±26 months
Mitral leaflets thickening documented at the time of diagnosis of ARF is a consistent prognostic marker for the subsequent evolution to Rheumatic heart disease (RHD)
Summary
Acute rheumatic fever (ARF) is a systemic inflammatory immunologically mediated complication of a streptococcal upper respiratory infection [1]. It involves, in most cases, the heart, joints, central nervous system, subcutaneous tissue and skin. The detection of echocardiographic signs of acute inflammatory changes in the absence of clinical signs of inflammation is widely recognized as evidence of subclinical carditis, with a mean prevalence of 16.8% in scarse published series with insufficient follow-up data [3, 5, 6]. It seems relevant to focus on early detection of those morphological and functional changes showing acute carditis and correlate them with extended follow-up data to provide a confirmation of its participation in the development of Rheumatic Heart Disease (RHD). No definitive diagnostic test for ARF exists and the role of Doppler echocardiography (DEC) for long-term prognostic evaluation following ARF is not well established
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