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Echocardiographic abnormalities in acute rheumatic fever
Insights
Echocardiography reveals distinct cardiac function patterns in children with acute rheumatic fever. Velocity of circumferential fiber shortening and left atrial dimension changes help assess carditis severity.
Area of Science:
- Pediatric Cardiology
- Rheumatic Heart Disease
- Diagnostic Imaging
Background:
- Acute rheumatic fever can lead to significant cardiac complications, including valve regurgitation and congestive heart failure.
- Serial assessment of cardiac function is crucial for managing pediatric rheumatic heart disease.
Purpose of the Study:
- To evaluate echocardiographic parameters, specifically velocity of circumferential fiber shortening and left atrial dimension, in children with acute rheumatic fever.
- To correlate these echocardiographic findings with the presence and severity of congestive heart failure.
Main Methods:
- Serial echocardiography was performed on two groups of children with acute rheumatic fever.
- Group I: valve regurgitation without congestive heart failure (n=6).
- Group II: valve regurgitation with congestive heart failure (n=7).
Main Results:
- Initial velocity of circumferential fiber shortening was elevated in Group I (1.90 circ/sec) and decreased in Group II (1.18 circ/sec).
- Left atrial dimension was mildly increased in Group I and significantly increased in Group II.
- Rebound in velocity of circumferential fiber shortening during corticosteroid withdrawal suggested impaired contractility in Group II.
Conclusions:
- Echocardiographic parameters, velocity of circumferential fiber shortening and left atrial dimension, can differentiate severity of carditis in acute rheumatic fever.
- These measurements facilitate serial assessment and monitoring of cardiac status in affected children.
- Echocardiography is a valuable tool for assessing carditis severity in acute rheumatic fever.
Abstract:
The echocardiographic velocity of circumferential fiber shortening and left atrial dimension were measured serially in two groups of children with acute rheumatic fever: Group I, six patients with valve regurgitation without congestive heart failure, and Group II, seven patients with regurgitation and congestive heart failure. In Group I, the initial velocity of circumferential fiber shortening was increased to 1.90 +/- 0.31 circumferences per second (circ/sec) (mean +/- standard deviation). In group II, it was decreased (1.18+/-0.25). In group I velocity of circumferential fiber shortening subsequently decreased but remained above the normal level; in Group II it increased to exceed the expected normal value. Concurrent changes in left atrial dimension were observed in both groups. The initial left atrial dimension of Group I (2.2 +/- 0.75 cm/m2) was slightly increased and returned to normal (1.70 +/- 0.32) on follow-up study. The left atrial dimension of Group II was greatly increased initially (2.70 +/- 0.81 cm/m2) and remained large (2.50 +/- 0.67). Three patients in Group II experienced rebound during corticosteroid withdrawal. In each the velocity of circumferential fiber shortening decreased, suggesting impaired cardiac contractility. The echocardiogram thus facilitates serial assessment of the severity of carditis in acute rheumatic fever.