Among 258 children and adolescents with acute rheumatic fever, 15.9% progressed to severe chronic valvar disease, predicted by moderate or severe carditis, recurrences, and low maternal education.
Cohort (n=258)
No
Moderate or severe carditis, recurrences of acute rheumatic fever, and low maternal education are key predictors of progression to severe chronic rheumatic valvar disease in children and adolescents.
OBJECTIVES: To investigate the progress of rheumatic fever (RF) and the predictors of severe chronic valvar disease. DESIGN: Patients prospectively followed up since their first attack of acute RF (ARF). SETTING: Universidade Federal de Minas Gerais, Brazil. PATIENTS: 258 children and adolescents who met the revised Jones criteria for RF. The follow up period ranged from 2-15 years. MAIN OUTCOME MEASURES: The presence and severity of mitral or aortic valvar disease were determined by both clinical and Doppler echocardiographic examinations. The variables associated with severe chronic valvar disease were initially identified by the Kaplan-Meier method and, later, by multivariate analysis. RESULTS: Doppler echocardiography of 258 patients studied showed that 186 (72.1%) developed chronic valvar disease and 41 (15.9%) progressed to severe chronic mitral or aortic lesions. Of 146 patients who developed carditis, 49 (33.6%) had a normal clinical examination in the chronic phase but only nine (6.2%) had normal Doppler echocardiographic findings--that is, 40 (27.4%) patients progressed to chronic subclinical valvar disease. Moderate or severe carditis, recurrences of ARF, and mother's low educational level were risk factors in predicting severe chronic valvar diseases. CONCLUSION: The increased risk of progressing to severe chronic valvar disease was associated with moderate or severe carditis, recurrences of ARF, and mother's low educational level. Hence, in a country such as Brazil, the options available for disease control are mainly primary and secondary prophylaxis.
Zilda Maria Alves Meira (2005) conducted a cohort in Rheumatic fever (n=258). Moderate or severe carditis, recurrences of acute rheumatic fever, and mother's low educational level was evaluated on Presence and severity of mitral or aortic valvar disease (severe chronic valvar disease). Among 258 children and adolescents with acute rheumatic fever, 15.9% progressed to severe chronic valvar disease, predicted by moderate or severe carditis, recurrences, and low maternal education.