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Tissue Doppler imaging in rheumatic carditis

Published online by Cambridge University Press:  14 March 2008

Tugcin Bora Polat*
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Yalim Yalcin
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Abdullah Erdem
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Cenap Zeybek
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Celal Akdeniz
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Ahmet Celebi
Affiliation:
Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
*
Correspondence to: Tugcin Bora Polat, 5. Gazeteciler sitesi A1 Blok 3 nolu villa, Akatlar-Istanbul/ Turkey. Tel: +90 (212) 324 10 19; Fax: +90 (212) 311 32 45; E-mail: tugcin75@mynet.com

Abstract

Objective

Our study was undertaken to assess cardiac functions by tissue Doppler echocardiography in patient with primary episode of rheumatic carditis.

Methods

We divided 82 patients with rheumatic carditis were divided in two groups; 50 patients with mild and 32 patients with mitral regurgitation of grade two or more. A control group consisted of 30 healthy children free of any disease. All children underwent conventional and tissue Doppler echocardiography initially and at the time of the follow-up examination.

Results

Myocardial systolic wave velocity of the mitral annulus was significantly higher in patients with mitral regurgitation of grade two or more when compared to the control group, but was not different between patients with mild mitral regurgitation and healthy subjects at the time of the initial attack. Myocardial precontraction time, myocardial contraction time, and the ratio of myocardial precontraction and contraction times were significantly prolonged, and the systolic myocardial velocity of the mitral annulus was significantly decreased in patients with mitral regurgitation of grade two or more at the time of the follow-up examination. The myocardial systolic wave velocity was significantly lower, and myocardial precontraction time, myocardial contraction time, and the ratio of the precontraction and contraction times, were significantly longer or greater between patients with grade two or more mitral regurgitation and the control group at follow-up examination.

Conclusion

We detected subclinical systolic dysfunction of the left ventricle in children with a primary episode of rheumatic carditis due to ongoing ventricular volume overload. Tissue Doppler imaging provides a quantifiable indicator useful for cardiac monitoring of disease during the period of follow up.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2008 

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References

1. Eisenberg, MJ. Rheumatic heart disease in the developing world: prevalence, prevention and control. Eur Heart J 1993; 14: 122128.Google Scholar
2. Narula, J, Chopra, P, Talwar, KK, et al. Does endomyocardial biopsy aid in the diagnosis of active rheumatic carditis? Circulation 1993; 88: 21982205.CrossRefGoogle ScholarPubMed
3. Taranta, A, Markowitz, M. Rheumatic Fever, 2nd ed. Kluwer Academic Publishers Dordrecht; 1989, p 19.Google Scholar
4. Vasan, RS, Shrivastava, S, Vijayakumar, M, Narang, J, Lister, BC, Narula, J. Echocardiographic evaluation of patients with acute rheumatic fever and rheumatic carditis. Circulation 1996; 94: 7384.Google Scholar
5. Essop, MR, Wisenbaugh, T, Sareli, P. Evidence against a myocardial factor as the cause of left ventricular dilation in active rheumatic fever. J Am Coll Cardiol 1993; 22: 826829.Google Scholar
6. Vinereanu, D, Ionescu, AA, Fraser, AG. Assessment of left ventricular long axis contraction can detect early myocardial dysfunction in asymptomatic patients with severe aortic regurgitation. Heart 2001; 85: 3036.Google Scholar
7. Nagueh, SF, Middleton, KJ, Kopelen, HA, Zoghbi, WA, Quinones, MA. Doppler tissue imaging: a technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol 1997; 30: 15271533.Google Scholar
8. Committee on Rheumatic Fever and Bacterial Endocarditis of the American Heart Association. Jones’ criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 1984; 69: 203208.Google Scholar
9. World Health Organization. Rheumatic fever and rheumatic heart disease: report of a WHO study group. Geneva, Switzerland World Health Organization; 1988, 5–58. WHO Technical Report Series 764.Google Scholar
10. Special Writing Group of the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease of the Council of Cardiovascular Disease in the Young of the American Heart Association. Guidelines for the diagnosis of rheumatic fever: Jones’ criteria, 1992 update. JAMA 1992; 268: 20692073.Google Scholar
11. Feinstein, AR, Spagnuolo, M. Mimetic features of rheumatic fever recurrences. N Engl J Med 1960; 262: 533535.Google Scholar
12. Brand, A, Dollberg, S, Keren, A. The prevalence of valvular regurgitation in children with structurally normal hearts: a color Doppler echocardiographic study. Am Heart J 1992; 123: 177180.Google Scholar
13. Sahn, DJ, Maciel, BC. Physiological valvular regurgitation: Doppler echocardiography and the potential for iatrogenic heart disease. Circulation 1988; 78: 10751077.Google Scholar
14. Helmcke, F, Nanda, NC, Hsiung, MC, et al. Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 1987; 75: 175183.Google Scholar
15. Perry, GJ, Helmcke, F, Nanda, NC, Byard, C, Soto, B. Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coll Cardiol 1987; 9: 952959.Google Scholar
16. Sahn, DJ, DeMaria, A, Kisslo, J, Weyman, A. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation 1978; 58: 10721083.Google Scholar
17. Teichholz, LE, Cohen, MV, Sonnenblick, EH, Gorlin, R. Study of left ventricular geometry and function by B-scan ultrasonography in patients with and without asynergy. N Engl J Med 1964; 291: 120128.Google Scholar
18. Feigenbaum, H, Popp, RL, Wolfe, SB. Ultrasound measurements of the left ventricle: correlations with angiocardiography. Arch Intern Med 1972; 1129: 461475.Google Scholar
19. Massel, BF, Fyler, DC, Roy, SB. The clinical picture of rheumatic fever: the diagnosis, immediate prognosis, course, and therapeutic implications. Am J Cardiol 1958; 1: 436449.Google Scholar
20. Sanyal, SK, Thapar, MK, Ahmed, SH, Hooja, V, Tewari, P. The initial attack of acute rheumatic fever during childhood in North India: a prospective study of the clinical profile. Circulation 1974; 49: 712.Google Scholar
21. Enriquez-Sarano, M, Tajik, A, Schaff, H, Orszulak, T, Bailey, K, Frye, R. Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. J Am Coll Cardiol 1994; 24: 15361543.Google Scholar
22. Enriquez-Sarano, M. Timing of mitral valve surgery. Heart 2002; 87: 7985.CrossRefGoogle ScholarPubMed
23. Agricola, E, Galderisi, M, Oppizzi, M, et al. Pulsed tissue Doppler imaging detects early myocardial dysfunction in asymptomatic patients with severe mitral regurgitation. Heart 2004; 90: 406410.Google Scholar
24. Pai, RG, Bodenheimer, MM, Pai, SM, Koss, JH, Adamick, RD. Usefulness of systolic excursion of the mitral anulus as an index of left ventricular systolic function. Am J Cardiol 1991; 67: 222224.CrossRefGoogle ScholarPubMed
25. Skoularigis, J, Sinovich, V, Joubert, G, Sareli, P. Evaluation of the long-term results of mitral valve repair in 254 young patients with rheumatic mitral regurgitation. Circulation 1994; 90: 6774.Google ScholarPubMed
26. Henry, WL, Bonow, RO, Rosing, DR, Epstein, SE. Observation on the optimum time for operative intervention for aortic regurgitation. II. Serial echocardiographic evaluation of asymptomatic patients. Circulation 1980; 61: 484492.Google Scholar
27. Starling, MR, Kirsh, MM, Montgomery, DG, Gross, MD. Mechanisms for left ventricular systolic dysfunction in aortic regurgitation: imporimportance for predicting the functional response to aortic valve replacement. J Am Coll Cardiol 1991; 17: 887897.Google Scholar
28. Wisenbaugh, T. Does normal pump function belie muscle dysfunction in patients with chronic severe mitral regurgitation. Circulation 1988; 77: 515525.Google Scholar
29. Villari, B, Campbell, ES, Hess, OM, et al. Influence of collagen network on left ventricular systolic and diastolic function in aortic valve disease. J Am Coll Cardiol 1993; 22: 14771484.Google Scholar
30. Ross, J Jr. The timing of surgery for severe mitral regurgitation. N Engl J Med 1996; 335: 14561458.Google Scholar
31. Sanyal, SK. Long term sequelae of the first attack of acute rheumatic fever in childhood. In: Emmanouilides GC, Riemenschneider TA, Allen HD, Gutgesell HP (eds). Heart Disease in Infants, Children and Adolescents. Williams & Wilkins, Baltimore, Md, 1995, pp 14161440.Google Scholar
32. Kadoba, K, Jonas, RA, Mayer, JE, Castaneda, AR. Mitral valve replacement in the first year of life. J Thorac Cardiovasc Surg 1990; 100: 762768.Google Scholar
33. Borkon, AM, Soule, L, Reitz, BA, Gott, VL, Gardner, TJ. Five-year follow-up after valve replacement with the St. Jude medical valve in infants and children. Circulation 1986; 74 suppl I: I-110I-115.Google Scholar
34. Schaffer, MS, Clarke, DR, Campbell, DN, Madigan, CK, Wiggins, JW, Wolfe, RR. The St. Jude Medical cardiac valve in infants and children: role of anticoagulant therapy. J Am Coll Cardiol 1987; 9: 235239.Google Scholar