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What is the True Frequency of Carditis in Acute Rheumatic Fever? A Prospective Clinical and Doppler Blind Study of 56 Children with up to 60 Months of Follow-Up Evaluation

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Abstract

Background This study aimed to evaluate prospectively clinical and echocardiographic findings of patients who had rheumatic fever with and without clinical features of cardiac involvement. Methods For this study, 56 consecutive patients (mean age, 11.4 years) with acute rheumatic fever diagnosed according to the 1992 modified Jones criteria were evaluated at diagnosis, after 3 and 6 months, then at 2 and 5 years. All assessments were performed blindly and included physical and cardiac examination, electrocardiogram, chest X-ray, and two-dimensional color-flow Doppler echocardiography. Results Initial clinical carditis was observed for 27 patients (48.2%), all of whom had positive echocardiographic abnormalities. Echocardiographic abnormalities were observed in 11 patients who had arthritis or chorea presentation without initial clinical carditis. Persistence of the abnormalities was observed at a late follow-up evaluation in 72.7% of the cases. Sydenham’s chorea was present in 8 patients with clinical carditis and in 10 without this disorder, 8 of whom had echocardiographic abnormalities. Conclusion Patients who had acute rheumatic fever without clinical signs of carditis showed acute and late follow-up echocardiographic abnormalities suggestive of cardiac involvement. Clinicians should be attentive for the presence of cardiac involvement among patients with chorea.

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Acknowledgments

This study was funded by Fapesp–Fundação de Amparo à Pesquisa do Estado de São Paulo.

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Authors and Affiliations

  1. Division of Allergy, Clinical Immunology and Rheumatology, Universidade Federal de São Paulo (UNIFESP), Rua dos Otonis 725, 04025-002, São Paulo, SP, Brazil

    Álvaro Manuel Caldas, Maria Teresa Ramos Ascensão Terreri, Cláudio Arnaldo Len & Maria Odete Esteves Hilário

  2. Rua Loefgreen 2381, apt 141, 04040-004, São Paulo, SP, Brazil

    Maria Teresa Ramos Ascensão Terreri

  3. Discipline of Cardiology, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), Rua dos Otonis 725, 04025-002, São Paulo, SP, Brazil

    Valdir Ambrosio Moises, Célia Maria Camelo Silva & Antonio Carlos Carvalho

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  1. Álvaro Manuel Caldas
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  2. Maria Teresa Ramos Ascensão Terreri
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  7. Maria Odete Esteves Hilário
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Correspondence to Maria Teresa Ramos Ascensão Terreri.

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Caldas, Á.M., Terreri, M.T.R.A., Moises, V.A. et al. What is the True Frequency of Carditis in Acute Rheumatic Fever? A Prospective Clinical and Doppler Blind Study of 56 Children with up to 60 Months of Follow-Up Evaluation. Pediatr Cardiol 29, 1048–1053 (2008). https://doi.org/10.1007/s00246-008-9242-z

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  • DOI: https://doi.org/10.1007/s00246-008-9242-z

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