Long term follow up of rheumatic fever and predictors of severe rheumatic valvar disease in Brazilian children and adolescents.
OBJECTIVE
To investigate the progress of rheumatic fever (RF) and the predictors of severe chronic valvar disease.


METHODS
Patients prospectively followed up since their first attack of acute RF (ARF).


METHODS
Universidade Federal de Minas Gerais, Brazil.


METHODS
258 children and adolescents who met the revised Jones criteria for RF. The follow up period ranged from 2-15 years.


METHODS
The presence and severity of mitral or aortic valvar disease were determined by both clinical and Doppler echocardiographic examinations. The variables associated with severe chronic valvar disease were initially identified by the Kaplan-Meier method and, later, by multivariate analysis.


RESULTS
Doppler echocardiography of 258 patients studied showed that 186 (72.1%) developed chronic valvar disease and 41 (15.9%) progressed to severe chronic mitral or aortic lesions. Of 146 patients who developed carditis, 49 (33.6%) had a normal clinical examination in the chronic phase but only nine (6.2%) had normal Doppler echocardiographic findings--that is, 40 (27.4%) patients progressed to chronic subclinical valvar disease. Moderate or severe carditis, recurrences of ARF, and mother's low educational level were risk factors in predicting severe chronic valvar diseases.


CONCLUSIONS
The increased risk of progressing to severe chronic valvar disease was associated with moderate or severe carditis, recurrences of ARF, and mother's low educational level. Hence, in a country such as Brazil, the options available for disease control are mainly primary and secondary prophylaxis.
Meira
Z M A
ZM
Department of Paediatrics, Universidade Federal de Minas Gerais, Belo Horizonte 31275030, Brazil. zilda.m.a.m@terra.com.br
Goulart
E M A
EM
Colosimo
E A
EA
Mota
C C C
CC
D000208:Acute Disease; D000293:Adolescent; D001021:Aortic Valve; D001938:Brazil / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000401:mortality*; D006801:Humans; D007223:Infant; D008297:Male; D008943:Mitral Valve; D015999:Multivariate Analysis; D009205:Myocarditis / Q000401:mortality; D011446:Prospective Studies; D012008:Recurrence; D012213:Rheumatic Fever / Q000000981:diagnostic imaging / Q000401:mortality*; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging / Q000401:mortality; D012307:Risk Factors; D012959:Socioeconomic Factors; D014463:Ultrasonography