Does rheumatic myocarditis really exists? Systematic study with echocardiography and cardiac troponin I blood levels.
OBJECTIVE
Revised guidelines for diagnosis of rheumatic fever indicate that rheumatic myocarditis may 'contribute' to the genesis of congestive heart failure. Our objective was to assess non-invasively the presence of non-clinical markers of myocardial involvement in acute rheumatic fever.


METHODS
Echocardiography and assessment of cardiac troponin I (cTnI) blood levels were systematically performed in 95 consecutive patients with acute rheumatic fever, who were divided into three groups. Group 1: patients without carditis (n=22); group 2: patients with carditis and without congestive heart failure (n=59); group 3: patients with carditis and congestive heart failure (n=14).


RESULTS
Left ventricular ejection fraction was normal in all patients and did not differ between groups (group 1: 0.72+/-0.08, group 2: 0.69+/-0.06, and group 3: 0.66+/-0.07, p=0.09). Left ventricular diameters tend to be larger in group 3, but all patients had severe mitral and/or aortic regurgitation. Mean cTnI was 0.077+/-0.017 ng/ml (normal <0.1 ng/ml), did not differ between groups (p=0.45), and only 13 patients (seven with pericardial effusion) had detectable levels (0.2-0.4 ng/ml).


CONCLUSIONS
Our study neither detected cTnI elevations nor echocardiographic abnormalities suggesting significant myocardial involvement during rheumatic fever. Congestive heart failure was always associated to severe valve regurgitation.
Kamblock
Joel
J
Centre de Cardiologie du Taaone, Pirae, Tahiti, French Polynesia. kamblock@mail.pf
Payot
Laurent
L
Iung
Bernard
B
Costes
Philippe
P
Gillet
Tristan
T
Le Goanvic
Christophe
C
Lionet
Philippe
P
Pagis
Bruno
B
Pasche
Jerome
J
Roy
Christine
C
Vahanian
Alec
A
Papouin
Gérard
G
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001022:Aortic Valve Insufficiency / Q000097:blood / Q000000981:diagnostic imaging; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000097:blood / Q000000981:diagnostic imaging; D009205:Myocarditis / Q000097:blood / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000097:blood / Q000000981:diagnostic imaging*; D019210:Troponin I / Q000097:blood*; D014463:Ultrasonography
D015415:Biomarkers; D019210:Troponin I