Key result
Silent carditis links to a 15% long-term valvular regurgitation recovery rate compared to evident carditis.
Why the study?
Rheumatic fever and rheumatic heart disease remain significant public health problems in developing countries, and the frequency and features of silent carditis require clarification.
Does Doppler echocardiography detect silent carditis and how does its prognosis compare to clinically evident carditis in patients with acute rheumatic fever?
Cohort (n=156)
Does Doppler echocardiography detect silent carditis and how does its prognosis compare to clinically evident carditis in patients with acute rheumatic fever?
Absolute Event Rate: 15% vs 18.5%
Doppler echocardiography is crucial for detecting silent carditis in acute rheumatic fever, which has a significant rate of persistent valvular regurgitation at long-term follow-up.
Silent carditis may warrant equivalent long-term surveillance as evident carditis; extends observational data on subclinical rheumatic heart disease but requires prospective validation.
BACKGROUND: Rheumatic fever and rheumatic heart disease continue to be an important public health problem in developing countries. Doppler echocardiography is now widely used for early detection and recurrence of clinical evident carditis (CC) and silent (subclinical) carditis (SC). The aim of this study was to determine the frequency of SC and to compare clinical and echocardiographic features of CC and SC. METHODS: A total of 156 consecutive patients diagnosed with acute rheumatic fever were included in the study. The patients without clinical evidence but with echocardiographic findings of carditis were diagnosed as having SC. RESULTS: Acute rheumatic fever was diagnosed in 156 patients, and 103 of these (66%) had carditis. The prevalence of SC was 28.2% among these 103 patients. Seventy-four of the patients with carditis were followed up for >1 year, and 20 of those had SC. Valvular regurgitation disappeared completely in 18.5% and improved in 45.5% of the CC patients. The recovery and improvement rates in the SC group were 15% and 30%, respectively. CONCLUSION: It is suggested that Doppler echocardiography be performed in all patients with suspected acute rheumatic fever for early detection of SC. Echocardiography should be used as a diagnostic criterion in order not to miss a diagnosis of SC.
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Pekpak et al. (2013) conducted a cohort in Acute rheumatic fever (n=156). Silent carditis vs. Clinical evident carditis was evaluated on Complete disappearance of valvular regurgitation (recovery). Silent carditis was associated with a 15% complete recovery rate of valvular regurgitation at >1 year follow-up, compared to 18.5% in patients with clinically evident carditis.
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