The efficacy of echocardiographic criterions for the diagnosis of carditis in acute rheumatic fever.
BACKGROUND
There is a great need for echocardiographic criterions for accurate diagnosis of carditis in acute rheumatic fever.


OBJECTIVE
To test the efficacy of proposed echocardiographic criterions for the diagnosis of carditis.


METHODS
We studied 333 patients suspected of having acute rheumatic fever, undertaking detailed clinical examination, laboratory tests and meticulous echocardiography in each case. We used previously established echocardiographic criterions for the diagnosis of carditis and subclinical valvitis. In 220 cases (66.06%), both the echo criterions, and the Jones' criterions, gave positive results. In 52 cases (15.61%), we found evidence of subclinical carditis, in that clinically no murmur was heard, meaning the Jones' criterions were negative, but the echocardiographic evaluation was positive. In 4 patients clinically diagnosed as having carditis, the Jones' criterions were positive, but echocardiographic evaluation showed them to have congenitally malformed hearts. In another 57 cases (17.11%), the Jones' criterions were negative, as were the results of echocardiographic evaluation. These patients were taken as control subjects. On this basis, the echocardiographic criterions had sensitivity of 81% and specificity of 93%.


CONCLUSIONS
Using our echocardiographic criterions, it is possible to make a precise diagnosis of carditis or subclinical valvitis. Hence, echocardiography should, in future, be included as a major criterion in the Jones' system.
Vijayalakshmi
Ishwarappa B
IB
Children's Heart Care Centre, Sri Jayadeva Institute of Cardiology, Bangalore, Karnataka, India. dr_vj@hotmail.com
Vishnuprabhu
Rajan O
RO
Chitra
Narasimhan
N
Rajasri
Ravindra
R
Anuradha
Thejoor V
TV
D016208:Databases, Factual; D004311:Double-Blind Method; D015150:Echocardiography, Doppler / Q000592:standards*; D005260:Female; D006337:Heart Murmurs / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D008297:Male; D009205:Myocarditis / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D017410:Practice Guidelines as Topic; D012214:Rheumatic Heart Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000503:physiopathology*; D012680:Sensitivity and Specificity