[Subclinical carditis during an initial attack of acute rheumatic fever: contribution of colored Doppler echocardiography and therapeutic advantages].

OBJECTIVE

To determine and to evaluate valvular involvement, in particular subclinical, as confirmed by colored Doppler echocardiography (CDE) during an initial attack of acute rheumatic fever (ARF). Means of diagnosis and therapeutic implications.

METHODS

Over a 7-year period, from January 1994 to December 2000, 49 patients (27 females and 22 males), with a mean age of 9.2 years (range 5-14 years), who presented with a first attack of ARF, were diagnosed on the basis of clinical data (history, physical findings, specific laboratory data, EKG, and CDE) to determine the major and minor criteria of acute rheumatic fever. All patients were reinvestigated and controlled clinically and by echocardiography two weeks to three months after the first investigation.

RESULTS

Reported clinical major criteria were: Arthritis, 46 cases (94%); carditis, 27 cases (55%); erythema marginatum, 3 cases (6%); subcutaneous nodules, 3 cases (6%) and chorea, 3 cases (6%). CDE abnormalities were identified in 37 cases with cardiac involvement (75% of patients), 10 of them had subclinical evidence of valvular involvement: 6 cases with mild to moderate mitral regurgitation (MR), 2 cases with moderate aortic regurgitation (AR), and 2 cases had both mild to moderate MR and moderate AR. All patients with subclinical disease and evidence of inflammatory process (7 cases) were treated by salicylates. Repeated echocardiography for control showed disappearance of valvular insufficiency in 8 patients with subclinical valvulopathy, and aggravation was observed in 2 other patients.

CONCLUSIONS

CDE is recommended in patients with suspicion of ARF, even in normal cardiac auscultation in order to detect an acute cardiac involvement leading to an early diagnosis. The confirmation of subclinical valvular disease should be considered as major criteria for ARF. Isolated and subclinical mitral and/or aortic regurgitations, with evidence of inflammatory process, should receive corticosteroids and be followed-up regularly, clinically and non-invasively by CDE.