Hostname: page-component-848d4c4894-v5vhk Total loading time: 0 Render date: 2024-06-22T10:37:28.615Z Has data issue: false hasContentIssue false
  • English
  • Français

QT Dispersion predicting acute rheumatic carditis

Published online by Cambridge University Press:  17 June 2010

Maria I. Remigio de Aguiar ,
Lurildo C. Ribeiro Saraiva  and
Cleusa L. Santos
Maria I. Remigio de Aguiar*
Affiliation:
Department of Cardiovascular Science, Clinical Hospital, Pernambuco Federal University, Recife-Pernambuco, Brazil
Lurildo C. Ribeiro Saraiva
Affiliation:
Department of Cardiovascular Science, Clinical Hospital, Pernambuco Federal University, Recife-Pernambuco, Brazil
Cleusa L. Santos
Affiliation:
Department of Cardiovascular Science, Clinical Hospital, Pernambuco Federal University, Recife-Pernambuco, Brazil
*
Correspondence to: Professor M. I. Remigio de Aguiar, Department of Cardiovascular Science, Clinical Hospital, Pernambuco Federal University, Irmã Maria David, 210/402, Recife, Pernambuco, Brazil. Tel: +55 81 3265 7398/55 81 9954 7557; Fax: +55 81 2126 8519; E-mail: miremigio@yahoo.com.br
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

To investigate QT dispersion in the surface electrocardiogram of children with rheumatic carditis.

Methods

QT dispersion was quantitatively evaluated in 33 children with acute rheumatic carditis. As a control group, we studied 33 healthy children free of any disease. The children were eligible for participation if the following criteria were met: diagnosis of acute rheumatic fever based on the revised Jone’s criteria and suffering from their first attack of carditis. The echo Doppler cardiogram was performed in all children, within 48–72 hours of hospitalisation.

Results

Patients with carditis had a greater QT dispersion than the control group. When we analyse the QT dispersion according to the severity of the carditis, we observed that the dispersion tended to be greater in those with more severe valvar lesion. The sensitivity and specificity of the measurements of the QT dispersion in predicting acute carditis were estimated by using receiver operating characteristic curves. A QT dispersion greater than 40 milliseconds had a sensitivity of 63.6% and a specificity of 93.9% in predicting acute rheumatic carditis.

Conclusion

The lengthening of QT dispersion may reflect on cardiac involvement in rheumatic fever and be a new important parameter in the diagnosis and therapeutic decision for rheumatic carditis.

Keywords

Electrocardiogramcardiac involvementrheumatic fever
Type
Original Articles
Information
Cardiology in the Young , Volume 20 , Issue 5 , October 2010 , pp. 473 - 476
Copyright
Copyright © Cambridge University Press 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Achutti, A, Achutti, VR. Epidemiology of rheumatic fever in developing world. Cardiol Young 1992; 2: 206–215.Google Scholar
2. Eisenberg, MJ. Rheumatic heart disease in the developing world: prevalence, prevention and control. Eur Heart 1993; 14: 122–128.CrossRefGoogle ScholarPubMed
3. Da Silva, NA, Pereira, BA. Acute rheumatic fever. Still a challenge. Rheum Dis Clin North Am 1997; 23: 545–568.CrossRefGoogle ScholarPubMed
4. Stollerman, GH. Rheumatic group A streptococci and the return of rheumatic fever. Adv Intern Med 1990; 35: 1–25.Google Scholar
5. Markowitz, M. Pioneers and modern ideas. Rheumatic fever: a half-century perspective. Pediatrics 1998; 102: 272–274.CrossRefGoogle ScholarPubMed
6. Krishnan, CS, Kushwaha, SS, Josephon, ME. Eletrocardiographic abnormalities and arrhythmias in patients with acute rheumatic fever. In Narula J, Virmane R and Reddy, Tandon E (eds). Rheumatic Fever. National Academy of Pathology, Washington, 1999; 283–297.Google Scholar
7. Zareba, W, Moss, AJ, Le Cersie, S. Dispersion of ventricular repolarization and arrhythmic death in coronary artery disease. Am J Cardiol 1994; 74: 550–553.CrossRefGoogle ScholarPubMed
8. Malik, M, Batchvarov, VN. Measurement, interpretation and clinical potential of QT dispersion. J Am Col Cardiol 2000; 36: 1749–1766.Google Scholar
9. Buja, G, Miorelli, M, Turrini, P, Melacini, P, Nava, A. Comparision of QT dispersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death. Am J Cardiol 1993; 72: 973–976.CrossRefGoogle Scholar
10. Polat, TB, Yalcin, Y, Akdeniz, C, Zeybek, C, Erdem, A, Celebi, A. QT dispersion in acute rheumatic fever. Cardiol Young 2006; 16: 141–146.Google Scholar
11. Committee on Rheumatic Fever and Bacterial Endocarditis of the American Heart Association. Jone’s criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 1984; 69: 203–208.Google Scholar
12. Special Writing Group of the Committeee on Rheumatic Fever, Endocarditis and Kawasaki Disease of the Council of Cardiovascular Disease in the Young of the American Heart Association. Guidelines for the diagnosisof rheumatic fever, Jone’s criteria, update. JAMA 1992; 268: 2069–2073.Google Scholar
13. Elmcke, F, Nanda, NC, Hsiung, MC. Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 1987; 75: 175–183.Google Scholar
14. 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: 952–959.Google Scholar
15. Zabel, M, Klingenheben, T, Franz, M, Hohnloser, S. Assessment of QT dispersion for prediction of mortality or arrhythmic events after myocardial infarction. Circulation 1998; 97: 2543–2550.CrossRefGoogle ScholarPubMed
16. Etheridge, SP, Shaddy, RE. QT dispersion after beta-blocker therapy in children with heart failure. Am J Cardiol 2003; 91: 1–5.CrossRefGoogle ScholarPubMed
17. Vialle, E, Albalkhi, R, Zimmerman, M, Friedli, B. Normal values of signal-averaged eletrocardiographic and QT dispersion in infants and children. Cardiol Young 1999; 9: 556–561.CrossRefGoogle Scholar
18. Marcfarlane, PW, McLaughlin, SC, Rodger, JC. Influence of lead selection and population on automated measurement of QT dispersion. Circulation 1998; 98: 2160–2167.CrossRefGoogle Scholar
19. Tutar, HE, Ocal, B, Imamoglu, A, Atalay, S. Dispersion of QT and QTc interval in healthy children, and effects of sinus arrhythmia on QT dispersion. Heart 1998; 80: 77–79.Google Scholar
20. Narula, J, Chandrasekhar, Y, Shahbudin, R, Rahimtoola, S. Diagnosis of active rheumatic carditis. The echoes of change. Circulation 1999; 100: 1576–1581.CrossRefGoogle ScholarPubMed
21. Mota, C. Doppler echocardiographic assessment of subclinical valvitis in the diagnosis of acute rheumatic fever. Cardiol Young 2001; 11: 251–254.Google Scholar
22. Ozkutlu, S, Ayabakan, C, Saraçlar, M. Can subclinical valvitis detected by echocardiography be accepted as evidence of carditis in the diagnosis of acute rheumatic fever? Cardiol Young 2001; 11: 255–260.CrossRefGoogle ScholarPubMed
23. Guven, B, Eroglu, AG, Babaoglu, K, et al. QT dispersion and diastolic functions in differential diagnosis of primary mitral valve prolapse and rheumatic mitral valve prolapse. Pediatr Cardiol 2008; 29: 352–358.CrossRefGoogle ScholarPubMed