title: Carotid intima media thickness and arterial stiffness in children with acute rheumatic fever.
abstract: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) constitute important public health problems in developing countries. Inflammation is present both in the early and late stages of the diseases. Chronic inflammation is known to be associated with atherosclerosis. We hypothesize that subclinical atherosclerosis and arterial stiffness may increase due to the ongoing inflammation as well as the increased pulse pressure and left-ventricular systolic dysfunction in RHD. The purpose of the present study was to investigate carotid intima media thickness (CIMT) and carotid artery stiffness in patients with ARF. Forty patients in follow-up due to ARF in the age group of 7-16 years (disease duration 1-10 years) and 36 volunteered subjects with similar body mass index were included in the study. The subjects included in the present study were compared regarding M-mode echocardiographic parameters and CIMT as well as carotid arterial strain (CAS), carotid artery distensibility (CAD), beta stiffness index (βSI), and pressure-strain elasticity modulus (Ep) as carotid artery stiffness parameters. CIMT (0.52 ± 0.08 and 0.48 ± 0.07 mm, p = 0.01), βSI (5.29 ± 2.98 and 3.02 ± 1.30, p < 0.001), and Ep (426.53 ± 210.50 and 254.44 ± 104.69 p < 0.001) were increased, whereas CAS (0.11 ± 0.01 and 0.19 ± 0.09, p < 0.001) and CAD (10.27 ± 4.69 and 17.76 ± 14.41, p < 0.001) were decreased in patients with ARF compared with the control group. There was a positive correlation between pulse pressure and βSI (r = 0.25, p = 0.02) and Ep (r = 0.28, p = 0.01) in addition to a correlation between left atrial dilatation and CIMT (r = 0.55 p < 0.001) in patients with ARF. CIMT and carotid artery stiffness were increased in patients with ARF. Patients with ARF may have an increased risk of subclinical atherosclerosis and cardiovascular events.
authors.affiliation: Department of Pediatric Cardiology, Erzurum Region Training and Research Hospital, Erzurum, Turkey, nefrotik@hotmail.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Çiftel
authors.forename: Osman
authors.initials: O
authors.lastname: Yılmaz
authors.forename: Fırat
authors.initials: F
authors.lastname: Kardelen
authors.forename: Abdullah
authors.initials: A
authors.lastname: Kocabaş
mesh_terms: D000293:Adolescent; D058070:Asymptomatic Diseases; D050197:Atherosclerosis / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D002648:Child; D003430:Cross-Sectional Studies; D004452:Echocardiography; D005260:Female; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000503:physiopathology; D008297:Male; D012213:Rheumatic Fever / Q000150:complications / Q000503:physiopathology; D013223:Statistics as Topic; D014421:Turkey; D059289:Vascular Stiffness; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology