title: What is the true frequency of carditis in acute rheumatic fever? A prospective clinical and Doppler blind study of 56 children with up to 60 months of follow-up evaluation.
abstract: BACKGROUND
  This study aimed to evaluate prospectively clinical and echocardiographic findings of patients who had rheumatic fever with and without clinical features of cardiac involvement.
  
  
  METHODS
  For this study, 56 consecutive patients (mean age, 11.4 years) with acute rheumatic fever diagnosed according to the 1992 modified Jones criteria were evaluated at diagnosis, after 3 and 6 months, then at 2 and 5 years. All assessments were performed blindly and included physical and cardiac examination, electrocardiogram, chest X-ray, and two-dimensional color-flow Doppler echocardiography.
  
  
  RESULTS
  Initial clinical carditis was observed for 27 patients (48.2%), all of whom had positive echocardiographic abnormalities. Echocardiographic abnormalities were observed in 11 patients who had arthritis or chorea presentation without initial clinical carditis. Persistence of the abnormalities was observed at a late follow-up evaluation in 72.7% of the cases. Sydenham's chorea was present in 8 patients with clinical carditis and in 10 without this disorder, 8 of whom had echocardiographic abnormalities.
  
  
  CONCLUSIONS
  Patients who had acute rheumatic fever without clinical signs of carditis showed acute and late follow-up echocardiographic abnormalities suggestive of cardiac involvement. Clinicians should be attentive for the presence of cardiac involvement among patients with chorea.
authors.affiliation: Division of Allergy, Clinical Immunology and Rheumatology, Universidade Federal de São Paulo, Rua dos Otonis, SP, Brazil.
authors.forename: Alvaro Manuel
authors.initials: AM
authors.lastname: Caldas
authors.forename: Maria Teresa Ramos Ascensão
authors.initials: MT
authors.lastname: Terreri
authors.forename: Valdir Ambrosio
authors.initials: VA
authors.lastname: Moises
authors.forename: Célia Maria Camelo
authors.initials: CM
authors.lastname: Silva
authors.forename: Cláudio Arnaldo
authors.initials: CA
authors.lastname: Len
authors.forename: Antonio Carlos
authors.initials: AC
authors.lastname: Carvalho
authors.forename: Maria Odete Esteves
authors.initials: MO
authors.lastname: Hilário
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D002648:Child; D018618:Echocardiography, Doppler, Color; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology; D011446:Prospective Studies; D012213:Rheumatic Fever / Q000150:complications*; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000382:microbiology