Valvular versus myocardial dysfunction in children with rheumatic fever

ABSTRACT

To study the myocardial factor in patients. with the initial attack of acute rheumatic fever [ARF]. Twenty-eight patients with initial attack of 8 without carditis [group 1] and 20 with carditis [group 2] were studied in the acute inflammatory stage of the disease and after subsidence of rheumatic activity. Control group included 8 healthy children. Levels of cardiac troponin-I [cTnI], creatine kinase-MB [CK-MB] as well as M-mode, Two-dimensional echocardiography and color Doppler examinations were performed in all patients and controls. Serum cTnI and CK-MB levels were not significantly different groups 1 and 2 compared with controls [P>0.05] and in group 1 com ed with group 2 [p>0.05]. Moreover, no change in cTnI, CK-MB or M-mode echocardiographic findings was found after subsidence of rheumatic activity [p>0, 05]. No correlation was found between serum cTnI, CK-and the severity of carditis as determined by chamber enlargement severity of valvular regurgitation by echocardiography [P>0.05]. Left ventricular fractional shortening, as an indicator of left ventricular systolic function was normal in patients enrolled in the study and did not differ between patient groups. No laboratory evidence of myocardial cell injury was demonstrated in patients with ARF. Moreover, echocardiographic evidence-of decreased systolic function of the left ventricle was lacking even presence of severe valvular regurgitation. This supports the current that acute valvular regurgitation, rather than myocardial involvement, is the major hemodynamic abnormality in these patients