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Prognostic value of clinical and Doppler echocardiographic findings in children and adolescents with significant rheumatic valvular disease.
[acute rheumatic fever]
The
diagnosis
of
acute
rheumatic
fever
(
RF
)
is
based
on
clinical
findings
.
However
,
during
the
chronic
phase
of
the
disease
,
the
clinical
approach
is
not
sufficient
for
the
follow-up
of
the
patients
and
the
Doppler
echocardiography
is
a
tool
for
the
diagnosis
of
cardiac
involvement
.
Prognostic
variables
that
influence
long
-term
outcomes
are
not
well
known
.
462
patients
with
RF
according
to
Jones
criteria
were
studied
,
and
followed-up
from
the
initial
attack
to
13
.
6
±
4
.
6
years
.
All
patients
underwent
clinical
assessment
and
Doppler
echocardiography
for
the
detection
of
heart
valve
involvement
in
the
acute
and
chronic
phases
.
Multivariate
logistic
regression
analysis
was
used
to
identify
the
factors
influencing
long
-term
heart
valve
disease
.
Carditis
occurred
in
55
.
8
%
and
subclinical
valvulitis
in
35
.
3
%
patients
.
In
the
chronic
phase
,
33
%
of
the
patients
had
significant
valvular
heart
disease
.
No
normal
Doppler
echocardiography
exam
was
observed
on
patients
who
had
severe
valvulitis
,
although
heart
auscultation
had
become
normal
in
13
%
of
these
.
In
the
multivariate
analysis
,
only
the
severity
of
carditis
and
the
mitral
and
/
or
aortic
valvulitis
were
associated
with
significant
valvular
heart
disease
.
Chorea
or
arthritis
were
protective
factors
for
significant
valvular
heart
disease
,
odds
ratio
0
.
41
(
95
%
C
.
I
.
0
.
22
-
0
.
77
)
and
0
.
43
(
95
%
C
.
I
.
0
.
23
-
0
.
82
)
,
respectively
.
Our
study
suggests
that
the
use
of
Doppler
echocardiography
during
RF
helps
to
identify
prognostic
factors
regarding
the
development
of
significant
valvular
heart
disease
.
Initial
severe
carditis
is
an
important
factor
in
the
long
-term
prognosis
of
chronic
RHD
,
whereas
arthritis
and
chore
during
the
initial
episode
of
RF
appears
to
be
protective
.
Strict
secondary
prophylaxis
should
be
mandatory
in
high
risk
patients
.
Diseases
Validation
Diseases presenting
"valvular heart disease"
symptom
acute rheumatic fever
dentinogenesis imperfecta
sneddon syndrome
This symptom has already been validated
