title: The case for utilizing more strict quantitative Doppler echocardiographic criterions for diagnosis of subclinical rheumatic carditis.
abstract: OBJECTIVE
  Our aim was to perform a comparative, quantitative and qualitative, analysis of valvar echocardiographic findings in patients with acute rheumatic fever, with or without clinical manifestations of carditis, as compared to healthy controls.
  
  
  RESULTS
  We analyzed cross-sectional Doppler echocardiographic images of 31 patients with acute rheumatic fever diagnosed according to the Jones criterions as modified in 1992. Of 31 patients, 22 presented with clinical carditis, while 9 had subclinical carditis. The patients, and a control group of 20 healthy individuals, underwent cardiac examination and echocardiographic assessment, assessing quantitative and qualitative findings of mitral and aortic valvar abnormalities. The leaflets of the mitral valve were statistically thicker in those with clinical and subclinical carditis when compared to controls (p less than 0.001). We observed a greater frequency of mitral variance, convergence of mitral flow, and aortic regurgitation for those with clinical and subclinical carditis when compared to controls (p less than 0.001, p less than 0.001 and p equal to 0.003, respectively). Patients with clinical and subclinical carditis had more quantitative and qualitative changes in the parameters than did the controls.
  
  
  CONCLUSIONS
  Echocardiography is a sensitive method to detect valvar abnormalities in patients with acute rheumatic fever and carditis. Additionally, by using regular standardized criterions, abnormalities that lead to a diagnosis of subclinical carditis are found in those patients with acute rheumatic fever in the apparent absence of cardiac involvement.
authors.affiliation: Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Universidade Federal de São Paulo, São Paulo - SP, Brazil.
authors.forename: Alvaro M
authors.initials: AM
authors.lastname: Caldas
authors.forename: Maria Teresa R A
authors.initials: MT
authors.lastname: Terreri
authors.forename: Valdir A
authors.initials: VA
authors.lastname: Moises
authors.forename: Celia M C
authors.initials: CM
authors.lastname: Silva
authors.forename: Antonio C
authors.initials: AC
authors.lastname: Carvalho
authors.forename: Maria Odete E
authors.initials: MO
authors.lastname: Hilário
mesh_terms: D000208:Acute Disease; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002648:Child; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity