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.
Centre de Cardiologie du Taaone, Pirae, Tahiti, French Polynesia. kamblock@mail.pf
Joel
J
Kamblock
Laurent
L
Payot
Bernard
B
Iung
Philippe
P
Costes
Tristan
T
Gillet
Christophe
C
Le Goanvic
Philippe
P
Lionet
Bruno
B
Pagis
Jerome
J
Pasche
Christine
C
Roy
Alec
A
Vahanian
Gérard
G
Papouin
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