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The efficacy of echocardiographic criterions for the diagnosis of carditis in acute rheumatic fever

Published online by Cambridge University Press:  01 December 2008

Ishwarappa B. Vijayalakshmi*
Affiliation:
Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Rajan O. Vishnuprabhu
Affiliation:
Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Narasimhan Chitra
Affiliation:
Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Ravindra Rajasri
Affiliation:
Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
Thejoor V. Anuradha
Affiliation:
Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India
*
Correspondence to: Dr. Ishwarappa B. Vijayalakshmi, MD, DM (Card), FICC, FIAMS, FIAE, FICP, FCSI, Professor of Pediatric Cardiology, Children’s Heart Care Centre, Sri Jayadeva Institute of Cardiology. Res: ‘Aditi’ 44 A, V Main road, Vijayanagar II stage, Bangalore-560040, Karnataka, India. Tel: 91 80 2330 2031, Mobile No: 094484940984; Fax: 91 80 2297 7236; E-mail: dr_vj@hotmail.com

Abstract

Background

There is a great need for echocardiographic criterions for accurate diagnosis of carditis in acute rheumatic fever.

Aim

To test the efficacy of proposed echocardiographic criterions for the diagnosis of carditis.

Materials and methods

We studied 333 patients suspected of having acute rheumatic fever, undertaking detailed clinical examination, laboratory tests and meticulous echocardiography in each case. We used previously established echocardiographic criterions for the diagnosis of carditis and subclinical valvitis. In 220 cases (66.06%), both the echo criterions, and the Jones’ criterions, gave positive results. In 52 cases (15.61%), we found evidence of subclinical carditis, in that clinically no murmur was heard, meaning the Jones’ criterions were negative, but the echocardiographic evaluation was positive. In 4 patients clinically diagnosed as having carditis, the Jones’ criterions were positive, but echocardiographic evaluation showed them to have congenitally malformed hearts. In another 57 cases (17.11%), the Jones’ criterions were negative, as were the results of echocardiographic evaluation. These patients were taken as control subjects. On this basis, the echocardiographic criterions had sensitivity of 81% and specificity of 93%.

Conclusion

Using our echocardiographic criterions, it is possible to make a precise diagnosis of carditis or subclinical valvitis. Hence, echocardiography should, in future, be included as a major criterion in the Jones’ system.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2008

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