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Ventricular dyssynchrony as a marker of latent carditis in children with acute rheumatic fever: A tissue Doppler imaging
Author(s) -
Mahfouz Ragab A.,
Alawady Waleed S.,
Salem Abdelhakeem
Publication year - 2017
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13720
Subject(s) - medicine , cardiology , carditis , doppler imaging , ventricular dyssynchrony , receiver operating characteristic , rheumatic fever , doppler echocardiography , heart failure , cardiac resynchronization therapy , diastole , ejection fraction , blood pressure
Objective We aimed to investigate the hypothesis that the presence of left ventricular ( LV ) dyssynchrony in children with acute rheumatic fever ( ARF ) children may be a predictor of latent rheumatic carditis. Methods Eighty‐nine children with ARF and 45 healthy control children were included the study. LV dyssynchrony was investigated by color‐coded tissue Doppler imaging. Results LV dyssynchrony parameters including Ts‐SD‐12, Ts‐12, Ts‐ SD ‐6, and Ts‐6 were found to be prolonged in children with ARF than in controls ( P < .001). We found that 45.2% in children with ARF without carditis had LV dyssynchrony (Ts‐ SD ‐12 ≥ 34.4 ms), while 63.4% in children with ARF with carditis had LV dyssynchrony. Follow‐up analysis demonstrated that children with arthritis and without dyssynchrony had no adverse events (recurrent rheumatic activity, development of valvular diseases; heart failure and atrial fibrillation), while those with LV dyssynchrony had events rate of 40.9% ( P < .001). Likewise, children with carditis had event rates of 63.4%. Ts‐ SD ‐12 was found to be correlated with hs‐ CRP ( r = .63; P < .001). Receiver‐operating characteristic ( ROC ) curve analysis showed that a Ts‐ SD ‐12 ≥ 36.5 was the optimal cutoff value in predicting unfavorable outcome in patients with ARF , with a sensitivity of 95% and specificity of 82%. Conclusions We found that children with ARF without any evidence of carditis had a significant LV systolic dyssynchrony spite of normal EF . LV dyssynchrony in those children had a significant event rates on follow‐up. These results highlighted the incremental value of LV dyssynchrony as a marker of subclinical carditis in children with ARF .