Does rheumatic myocarditis really exists? Systematic study with echocardiography and cardiac troponin I blood levels

• Published in: European heart journal 2003-05, Vol.24 (9), p.855-862
• Main Authors: Kamblock, Joel, Payot, Laurent, Iung, Bernard, Costes, Philippe, Gillet, Tristan, Le Goanvic, Christophe, Lionet, Philippe, Pagis, Bruno, Pasche, Jerome, Roy, Christine, Vahanian, Alec, Papouin, Gérard
• Format: Article
• Language: English
• Subjects: Acute Disease; Adolescent; Adult; Aortic Valve Insufficiency - blood; Aortic Valve Insufficiency - diagnostic imaging; Biomarkers - blood; Child; Child, Preschool; Diagnosis, Differential; Echocardiography; Female; Heart Failure - blood; Heart Failure - diagnostic imaging; Humans; Male; Mitral Valve Insufficiency - blood; Mitral Valve Insufficiency - diagnostic imaging; Myocarditis; Myocarditis - blood; Myocarditis - diagnostic imaging; Prospective Studies; Rheumatic fever; Rheumatic Heart Disease - blood; Rheumatic Heart Disease - diagnostic imaging; Troponin; Troponin I - blood; Ultrasonography
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1016/S0195-668X(02)00825-4

Aims Revised guidelines for diagnosis of rheumatic fever indicate that rheumatic myocarditis may ‘contribute’ to the genesis of congestive heart failure. Our objective was to assess non-invasively the presence of non-clinical markers of myocardial involvement in acute rheumatic fever. Methods Echocardiography and assessment of cardiac troponin I (cTnI) blood levels were systematically performed in 95 consecutive patients with acute rheumatic fever, who were divided into three groups. Group 1: patients without carditis \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((n=22)\) \end{document}; group 2: patients with carditis and without congestive heart failure \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((n=59)\) \end{document}; group 3: patients with carditis and congestive heart failure \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((n=14)\) \end{document}. Results Left ventricular ejection fraction was normal in all patients and did not differ between groups (group 1: 0.72±0.08, group 2: 0.69±0.06, and group 3: 0.66±0.07, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(p=0.09\) \end{document}). Left ventricular diameters tend to be larger in group 3, but all patients had severe mitral and/or aortic regurgitation. Mean cTnI was 0.077±0.017ng/ml (normal