Parameters indicative of persistence of valvular pathology at initial diagnosis in acute rheumatic carditis: the role of albumin and CD19 expression / Parâmetros indicativos de persistência de patologia valvular no diagnóstico inicial de cardite reumática aguda: o papel da albumina e da expressão de CD19

Abstract Objective: The aim of this study is to define the predictors of chronic carditis in patients with acute rheumatic carditis (ARC). Methods: Patients diagnosed with ARC between May 2010 and May 2011 were included in the study. Echocardiography, electrocardiography, lymphocyte subset analysis, acute phase reactants, plasma albumin levels, and antistreptolysin-O (ASO) tests were performed at initial presentation. The echocardiographic assessments were repeated at the sixth month of follow-up. The patients were divided into two groups according to persistence of valvular pathology at 6th month as Group 1 and Group 2, and all clinical and laboratory parameters at admission were compared between two groups of valvular involvement. Results: During the one-year study period, 22 patients had valvular disease. Seventeen (77.2%) patients showed regression in valvular pathology. An initial mild regurgitation disappeared in eight patients (36.3%). Among seven (31.8%) patients with moderate regurgitation initially, the regurgitation disappeared in three, and four patients improved to mild regurgitation. Two patients with a severe regurgitation initially improved to moderate regurgitation (9.1%). In five (22.8%) patients, the grade of regurgitation [moderate regurgitation in one (4.6%), and severe regurgitation in 4 (18.2%)] remained unchanged. The albumin level was significantly lower at diagnosis in Group 2 (2.6 ± 0.48 g/dL). Lymphocyte subset analysis showed a significant decrease in the CD8 percentage and a significant increase in CD19 percentage at diagnosis in Group 2 compared to Group 1. Conclusion: The blood albumin level and the percentage of CD8 and CD19 (+) lymphocytes at diagnosis may help to predict chronic valvular disease risk in patients with acute rheumatic carditis.

Resumo Objetivo: Definir os preditores da cardite crônica em pacientes com cardite reumática aguda (CRA). Métodos: Os pacientes diagnosticados com CRA entre maio de 2010 e maio de 2011 foram incluídos no estudo. Foram feitos os testes de ecocardiografia, eletrocardiograma, uma análise do subgrupo de linfócitos, provas de fase aguda, níveis de albumina plasmática, antiestreptolisina-O (ASO) na manifestação inicial. As avaliações ecocardiográficas foram repetidas no 6º mês de acompanhamento. Os pacientes foram divididos em dois grupos de acordo com a persistência da patologia valvular no 6º mês como Grupo 1 e Grupo 2 e todos os parâmetros clínicos e laboratoriais na internação foram comparados entre dois grupos de comprometimento valvular. Resultados: Durante o período do estudo de um ano, 22 pacientes apresentaram doença valvular; 17 (77,2%) apresentaram regressão da patologia valvular. Houve desaparecimento de regurgitação moderada inicial em oito pacientes (36,3%). Entre sete (31,8%) pacientes com regurgitação moderada inicialmente, a regurgitação desapareceu em três e quatro apresentaram melhoria para regurgitação leve. Dois pacientes com regurgitação grave inicialmente apresentaram melhoria para regurgitação moderada (9,1%). Em cinco (22,8%) pacientes o grau de regurgitação (regurgitação moderada em um [4,6%] e regurgitação grave em quatro [18,2]) continuou inalterado. O nível de albumina foi significativamente menor no diagnóstico no Grupo 2 (2,6 ± 0,48 gr/dL). A análise do subgrupo de linfócitos mostrou uma redução significativa no percentual de CD8 e um aumento significativo no percentual de CD19 no Grupo 2 em comparação com o Grupo 1. Conclusão: O nível de albumina no sangue e o percentual de linfócitos CD8 e CD19 (+) no diagnóstico podem ajudar a prever risco de doença valvular crônica em pacientes com cardite reumática aguda.

IL-10 and ET-1 as biomarkers of rheumatic valve disease / IL-10 e ET-1 como biomarcadores de doença valvar reumática

Objective: To evaluate the immunological profile and gene expression of endothelin-1 (ET-1) in mitral valves of patients with rheumatic fever originated from a reference service in cardiovascular surgery. Methods: This was a quantitative, observational and cross-sectional study. Thirty-five subjects (divided into four groups) participated in the study, 25 patients with chronic rheumatic heart disease and ten control subjects. The mean age of the sample studied was 34.5 years. Seventeen of them (48.58%) were male and 18 (51.42%) were female. Inflammatory cytokines (TNF-α, IL-4 and IL-10) were measured and ten mitral valves of patients who underwent first valve replacement were collected for determination of gene expression of endothelin-1 by real time PCR. Results: Among the groups studied (patients vs. controls), there was a statistically significant difference in IL-10 levels (P=0.002), and no differences in other cytokines. Expression of endothelin-1 was observed in 70% of samples. Quantitatively, average of ET-1 expression was 62.85±25.63%. Conclusion: Inflammatory cytokine IL-10 participates in the maintenance of chronicity of rheumatic fever in patients who underwent valve replacement and those who are undergoing medical treatment. The expression of endothelin-1 in heart valve lesions in patients undergoing mitral valve replacement confirms its association with inflammatory activity in rheumatic fever. .

Objetivo: Avaliar o perfil imunológico e a expressão gênica de endotelina-1 em valvas mitrais de pacientes com febre reumática, originados de um serviço de referência em cirurgia cardiovascular. Métodos: Este foi um estudo quantitativo, observacional e transversal. Trinta e cinco indivíduos (divididos em quatro grupos) participaram do estudo, 25 deles com doença cardíaca reumática crônica, além de 10 controles. A média de idade da amostra estudada foi de 34,5 anos. Dezessete (48,58%) dos indivíduos eram homens, e 18 (51,42%) eram mulheres. Foram medidas algumas citocinas inflamatórias (TNF-α, IL-4 e IL-10) e coletadas 10 valvas mitrais de pacientes que se submeteram a primeira troca valvar para determinação da expressão gênica de endotelina-1 pelo PCR real-time. Resultados: Entre os grupos estudados (pacientes e controles), observou-se diferença estatisticamente significante em relação aos níveis de IL-10 (P=0,002), sem diferenças nas outras citocinas. Em relação à endotelina-1, foi observada sua expressão em 70% das amostras. Quantitativamente, a expressão média de endotelina-1 foi de 62,85±25,63%. Conclusão: A citocina inflamatória IL-10 participa da manutenção da cronicidade da febre reumática em pacientes que se submeteram a troca valvar e naqueles que estão em tratamento médico. A expressão de endotelina-1 nas lesões em valvas cardíacas de pacientes que foram submetidos à troca valvar mitral confirma sua relação com a atividade inflamatória na febre reumática. .

Serum cardiac troponin-I in active rheumatic carditis.

OBJECTIVE: The study was performed to investigate the level of serum cardiac troponin I (cTnI), a specific marker for myocardial cell damage, in the acute rheumatic carditis (RC). METHODS: Twenty seven consecutive patients with acute RC and 23 healthy children were enrolled. RESULT: cTnI level in both groups showed no statistical difference (p > 0.05). CONCLUSION: Serum cTnI level did not gain clinical use.

Serum adenosine deaminase and cytidine deaminase as markers of active disease in childhood rheumatic disorders

Serum cytidine deaminase [CD] and adenosine deaminase [AD] activities were measured in 21 children with juvenile rheumatoid arthritis [JRA], 21 with SLE and other rheumatic diseases and 11 with active rheumatic fever [RF] in comparison with 19 healthy controls aiming at assessing their activities in such diseases and their relation in clinical and laboratory markers of the disease activity. The mean serum CD and AD activities were significantly higher in patients' groups than in controls. The increase in CD activity was more prominent in JRA and RF, while AD was highest in SLE. Patients with active JRA had higher CD activity than that with quiescent disease. AD was insignificantly higher in quiescent disease. The activity of both enzymes was insignificantly higher in active as compared to quiescent SLE. Although paired observations of eight patients revealed a drop in the activity of both enzymes with a disease remission, yet the levels remained significantly higher than in controls indicating an ongoing subclinical inflammation. The activity of both enzymes did not correlate significantly neither with ESR nor with serum complement C3 activity. No significant differences were observed with various modes of therapy [steroids, NSAIDs] of JRA. Cytotoxic drugs for SLE were accompanied by a significantly higher CD than steroid therapy

Salicylate level and liver function tests in patients with rheumatic fever and rheumatic heart diseases

This study was carried on 48 cases, their ages ranged from 6 to 12 years. They were classified into 3 groups: 20 patients with rheumatic carditis [group I] and 18 patients with rheumatic arthritis [group II], both groups were in salicylate therapy 100 mg/kg/day. Both groups were matched with 10 apparently healthy children considered as controls. Liver function tests including serum bilirubin, AST, ALT, ALP, GGT, serum albumin and TSP were estimated for all groups and salicylate level for those receiving salicylates. The effect of salicylate therapy in the usual therapeutic dose in rheumatic patients appears to decrease slightly serum proteins and slightly increases liver enzymes AST, ALP and serum bilirubin level. No correlation was found between the dose of salicylate or its duration and the level of hepatic enzymes. There was only a weak negative correlation between the salicylate level and the values of total serum proteins and albumin

Doença reumática ativa fatal: estudo de 13 casos de necrópsia / Fatal active rheumatic disease. Study of 13 necropsy cases

Casuística e Métodos - Teze portadores de DR ativa fatal, de idades entre 4,5 e 25 (média de 14) anos, oito (61,5%) do sexo masculino, com diagnóstico confirmado pela necrópsia. Constituiram-se: grupo A: idade até 15 anos (8 casos), e grupo B: idade superior a 15 anos (5 casos). Resultados - O quadro clínico principal foi febre associada a insuficiência cardíaca grave em todos os casos. No grupo A, foi o primeiro surto reumático em 5 casos e o tempo decorrido entre o início dos sintomas e a hospitalizaçäo variou de 10 a 90 (média de 40) dias; insuficiência mitral ocorreu em todos os casos, em seis a taxa de leucócitos foi superior a 10000 por mm3 e em sete a taxa de mucocproteínas foi superior a 8 mg/dl; bloqueio atrioventricular de 1§ grau ocorreu em um caso; vegetaçöes valvares ao ecocardiograma foram reconhecidas em 5 casos. Dois casos receberam antibiotioterapia, cinco prednisona e depois antibióticos, e um antibióticos e depois prednisona; tratamento cirúrgico da disfunçäo valvar foi realizado em um paciente. No grupo B, foi o primeiro surto reumático em dois casos, o tempo decorrido entre o início dos sintomas e a hospitalizaçäo variou de 4 a 60 (média de 21) dias; em quatro casos a taxa de leucócitos fou superior a 10000 por mm3 e a taxa de mucoproteiína foi superior a 8 mg/dl em 2 casos; bloqueio atrioventricular foi diagnosticado em um caso; Vegetaçöes valvares foram reconhecidas ao ecocardiograma em dois casos; em dois casos foi aplicada antibioticoterapia e em três foi indicado o tratamento cirúrgico. Conclusäo - A DR ativa pode ter evoluçäo fatal mesmo no primeiro surto ou já na terceira década da vida. Outros diagnósticos säo freqüentemente cogitados, em funçäo de manifestaçöes clínicas e laboratoriais muito intensas

Non-surgical mitral valvuloplasty for rheumatic mitral stenosis.

One hundred and twenty-six patients of rheumatic mitral stenosis (MS), aged 10-30 (mean 19.5 +/- 5.9) years underwent balloon mitral valvuloplasty (BMV). All valvuloplasties were done by the anterograde transvenous, transatrial route. The procedure was successful in 120 (95%) cases. Single balloon was used in 10 patients early in the series and double balloon was used in the other 110 patients. BMV resulted in a significant increase in the mitral valve area (MVA) from 0.96 +/- 0.35 to 2.3 +/- 0.8 cm2 (p less than 0.0001) and a significant fall in the transmitral pressure gradient (TMG) from 28.2 +/- 3.2 to 7.4 +/- 4.8 mmHg (p less than 0.001). The MVA achieved by BMV was found to have a significant positive correlation with the balloon diameter to body surface area ratio (BD/BSA) (r = 0.69, p less than 0.001). New mitral regurgitation (MR) developed in 15 patients--trivial in 11, 2+ in 2 and 3+ in 2. One patient required emergency mitral valve replacement. Procedure induced MR did not have a significant relation to the balloon size, degree of mitral sub-valvular pathology or the severity of mitral stenosis. Iatrogenic atrial septal defect was detected by oximetry in none, by angiography in one patient, and by Doppler color flow imaging in 5 patients. Cardiac tamponade was the most frequent serious complication, occurring in 6 patients, 4 of whom died following emergency surgery. Sixty-five patients have been followed up for at least 6 months (range 6-30, mean 16.3 +/- 6.3 months) following BMV.(ABSTRACT TRUNCATED AT 250 WORDS)