Beg Ahsan, Sadiq Masood
Department of Paediatric Cardiology, The Children's Hospital/The Institute of Child Health, Lahore, Pakistan.
Pediatr Cardiol. 2008 May;29(3):619-23. doi: 10.1007/s00246-007-9173-0. Epub 2007 Dec 20.
Doppler echocardiography facility is now available in most parts of the world and its routine use for the initial diagnosis of acute rheumatic fever (ARF) might enhance its early detection and, hence, prevention of rheumatic recurrences. To add to the existing evidence and to reemphasize the need of including echocardiography as a diagnostic criterion for ARF, we investigated the pattern and prevalence of subclinical valvulitis by Doppler echocardiography in patients with ARF manifesting as either pure chorea or isolated arthritis but without clinical signs of carditis. This prospective study was carried out in a single center over a period of 6 months (June to December 2006). Thirty patients with ARF, 16 males and 14 females, aged 4-15 years (mean: 10 +/- 3.2) presenting with either chorea or isolated arthritis were included by convenience sampling. Evidence of carditis as detected by echocardiography was present in 21 patients (70%). Chorea was the presenting feature in 19 patients (63%), followed by migratory polyarthritis in 11 (37%). Among patients with chorea, 13 (68%) had evidence of carditis. Mitral regurgitation (MR) was present in all 13, being isolated in 11 and with aortic regurgitation (AR) in 2 patients. In patients with migratory polyarthritis, 8 (73%) had evidence of carditis, all with isolated MR. Echocardiography detected subclinical valvulitis in at least 70% of patients with ARF presenting with either rheumatic chorea or migratory arthritis but no clinical evidence of carditis. MR was the predominant lesion present in all patients either in isolation (90%) or in combination with AR (10%). We suggest that Doppler echocardiography be performed in all patients with suspected ARF and evidence of subclinical valvulitis be used as a diagnostic criterion.
如今，世界上大多数地区都具备多普勒超声心动图设备，将其常规用于急性风湿热（ARF）的初步诊断，可能会提高早期发现率，从而预防风湿热复发。为补充现有证据并再次强调将超声心动图纳入ARF诊断标准的必要性，我们通过多普勒超声心动图研究了表现为单纯舞蹈病或孤立性关节炎但无心脏炎临床体征的ARF患者亚临床瓣膜炎的模式和患病率。这项前瞻性研究在一个中心进行，为期6个月（2006年6月至12月）。通过方便抽样纳入了30例ARF患者，其中男性16例，女性14例，年龄4至15岁（平均：10±3.2岁），表现为舞蹈病或孤立性关节炎。超声心动图检测到心脏炎证据的患者有21例（70%）。舞蹈病是19例患者（63%）的首发症状，其次是11例（37%）的游走性多关节炎。在舞蹈病患者中，13例（68%）有心脏炎证据。所有13例均存在二尖瓣反流（MR），其中11例为孤立性，2例合并主动脉瓣反流（AR）。在游走性多关节炎患者中，8例（73%）有心脏炎证据，均为孤立性MR。超声心动图在至少70%表现为风湿性舞蹈病或游走性关节炎但无心脏炎临床证据的ARF患者中检测到亚临床瓣膜炎。MR是所有患者中主要的病变，要么孤立存在（90%），要么与AR合并存在（10%）。我们建议对所有疑似ARF的患者进行多普勒超声心动图检查，并将亚临床瓣膜炎的证据用作诊断标准。
