Echocardiographic and Laboratory Findings of  Turkish Children during the First Attack of Acute  Rheumatic Fever

Erman  Çilsal; Ayhan Pektaş; Bilgehan M.  Pektaş; Buğra H.  Koca

doi:10.5152/EurJTher.2017.191

Authors

Erman Çilsal Clinic of Pediatric Cardiology, Adana City Training and Research Hospital
Ayhan Pektaş Department of Pediatric Cardiology, Afyon Health Sciences University School of Medicine Hospital
Bilgehan M. Pektaş Department of Pharmacology, Afyon Health Science University School of Medicine
Buğra H. Koca Department of Medical Biochemistry, Afyon Health Science University School of Medicine

DOI:

https://doi.org/10.5152/EurJTher.2017.191

Keywords:

Acute rheumatic fever, carditis, children, Doppler echocardiography

Abstract

Objective: In this study, we aim to determine demographic features and laboratory data of Turkish children who are diagnosed with acute rheumatic carditis and to evaluate echocardiographic indices of the left ventricle (LV) and right ventricle (RV) systolic-diastolic functions at the time of diagnosis.
Methods: This is a retrospective review of 100 children who were hospitalized because of the diagnosis of acute rheumatic fever (ARF)-related acute-stage carditis and 100 healthy children who were matched with respect to age and body mass index. All subjects initially underwent detailed two-dimensional (2D), pulsed Doppler, and tissue Doppler for assessment of ventricular functions.
Results: Internal diameter of LV, measured during end-systole, was significantly increased and the mitral annular plane systolic excursion was decreased in patients compared with those in controls (p=0.005). Although E’ velocity derived from septal mitral annulus were significantly lower, isovolumetric contraction time and myocardial performance index were increased in the carditis group compared with that in the control group. Peak early diastolic (E’), late diastolic (A’), and systolic (S’) myocardial velocities; isovolumetric contraction time; and myocardial performance index measured from the tricuspid annulus were similar in the carditis and control groups, although isovolumetric relaxation time was significantly prolonged. The carditis group had significantly lower
mean corpuscular and platelet volume than the control group, although erythrocyte sedimentation rate and serum C-reactive protein levels were higher.
Conclusion: We detected a subclinical reduction in the systolic and diastolic function of both ventricles in children with the first attack of ARF. “Pulsed” and tissue Doppler techniques in pediatric patients with ARF have an important role in assessing cardiac functions.

Metrics

Metrics Loading ...

References

Webb RH, Grant C, Harnden A. Acute rheumatic fever. BMJ 2015; 351: 3443.

Markham R, Tulloh R. Fifteen-minute consultation: rheumatic fever. Arch Dis Child Educ Pract Ed 2015; 100: 176-9.

Jaggi P. Rheumatic fever and post group-a streptococcal arthritis. Pediatr Infect Dis J 2011; 30: 424-5.

Burke RJ, Chang C. Diagnostic criteria of acute rheumatic fever. Autoimmun Rev 2014; 13: 503-7.

Watson G, Jallow B, Le Doare K, Pushparajah K, Anderson ST. Acute rheumatic fever and rheumatic heart disease in resource-limited settings. Arch Dis Child 2015; 100: 370-5.

Steer AC, Carapetis JR. Acute rheumatic fever and rheumatic heart disease in indigenous populations. Pediatr Clin North Am 2009; 56: 1401-19.

Marijon E, Mirabel M, Celermajer DS, Jouven X. Rheumatic heart disease. Lancet 2012; 379: 953-64.

Essop MR, Peters F. Contemporary issues in rheumatic fever and chronic rheumatic heart disease. Circulation 2014; 130: 2181-8.

de Dassel JL, Ralph AP, Carapetis JR. Controlling acute rheumatic fever and rheumatic heart disease in developing countries: are we getting closer? Curr Opin Pediatr 2015; 27: 116-23.

Committee on Rheumatic Fever, Bacterial Endocarditis of the American Heart Association. Jones criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 1984; 69: 204-8.

Report of a WHO expert consultation. WHO Expert Consultation on Rheumatic Fever and Rheumatic Heart Disease. 2001 October 29-November 1, Geneva, Switzerland. WHO Technical Report Series. World Health Organ Tech Rep Ser 2004; 923: 1-122.

Teichholz LE, Kreulen T, Herman MV, Gorlin R. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol 1976: 37: 7-11.

Cui W, Roberson DA. Left ventricular Tei index in children: comparison of tissue Doppler imaging, pulsed wave Doppler, and M-mode echocardiography normal values. J Am Soc Echocardiogr 2006: 19: 1438-45.

Carapetis JR, McDonald M, Wilson NJ. Acute rheumatic fever. Lancet 2005; 366: 155-68.

Guilherme L, Kalil J. Rheumatic fever: the T cell response leading to autoimmune aggression in the heart. Autoimmun Rev 2002; 1: 261-6.

Kotby AA, El-Shahed GS, Elmasry OA, El-Hadidi IS, El Shafey RN. N-Terminal proBNP Levels and Tissue Doppler Echocardiography in Acute Rheumatic Carditis. ISRN Pediatr 2013: 2013: 970394.

Enriquez-Sarano M. Timing of mitral valve surgery. Heart 2002; 87: 79-85.

Khouri SJ, Maly GT, Suh DD, Walsh TE. A practical approach to the echocardiographic evaluation of diastolic function. J Am Soc Echocardiogr 2004: 17: 290-7.

Waggoner AD, Bierig SM. Tissue Doppler imaging: a useful echocardiographic method for the cardiac sonographer to assess systolic and diastolic ventricular function. J Am Soc Echocardiogr 2001: 14: 1143-52.

Polat TB, Yalcin Y, Erdem A, Zeybek C, Akdeniz C, Celebi A. Tissue Doppler imaging in rheumatic carditis. Cardiol Young 2014; 24: 359-65.

Agricola E, Galderisi M, Oppizzi M, Schinkel AF, Maisano F, De Bonis M, et al. Pulsed tissue Doppler imaging detects early myocardial dysfunction in asymptomatic patients with severe mitral regurgitation. Heart 2004; 90: 406-10.

Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des 2011; 17: 47-58.

Gruys E, Toussaint MJ, Niewold TA, Koopmans SJ. Acute phase reaction and acute phase proteins. Journal of Zhejiang Univ Sci B 2005; 6: 1045-56.

Özdemir R, Karadeniz C, Doksoz O, Celegen M, Yozgat Y, Guven B, et al. Are mean platelet volume and platelet distribution width useful parameters in children with acute rheumatic carditis? Pediatr Cardiol 2014; 35: 53-6.

Sert A, Aypar E, Odabas D. Mean platelet volume in acute rheumatic fever. Platelets 2013; 24: 378-82.

Polat N, Yildiz A, Yuksel M, Bilik MZ, Aydin M, Acet H, et al. Association of neutrophil-lymphocyte ratio with the presence and severity of rheumatic mitral valve stenosis. Clin Appl Thromb Hemost 2014; 20: 793-8.

Turner MW. The role of mannose-binding lectin in health and disease. Mol Immunol 2003; 40: 423-9.

Messias Reason IJ, Schafranski MD, Jensenius JC, Steffensen R. The association between mannose-binding lectin gene polymorphism and rheumatic heart disease. Hum Immunol 2006; 67: 991-8.