Prospective comparison of clinical and echocardiographic diagnosis of rheumatic carditis: long term follow up of patients with subclinical disease

Objective-To determine the frequency of occurrence and long term evolution of subclinical carditis in patients with acute rheumatic fever. Design-Valvar incompetence was detected by clinical examination and Doppler echocardiographic imaging during the acute and quiescent phases of rheumat ic fever. Patients were followed prospectively and submitted to repeat exam inations at one and fire years after the acute attack. Persistence of acute mitral and aortic lesions detected solely by echocardiography (subclinical . disease) was compared with that of disease detected by clinical examinati on as well (thereby fulfilling the latest 1992 Jones criteria for rheumatic carditis). Setting-Three general hospitals with a university affiliation in Chile. Patients-35 consecutive patients fulfilling the revised Jones criteria for rheumatic fever. Clinical and echocardiographic examination was repeated in 32 patients after one year and in 17 after five years. Ten patients had su bclinical carditis on admission, six of whom were followed for five years. Main outcome measures-Auscultatory and echocardiographic evidence of mitral or aortic regurgitation during the acute attack or at follow up. Results-Mitral or aortic regurgitation was detected by Doppler echocardiogr aphic imaging in 25/35 rheumatic fever patients as opposed to 5/35 by clini cal examination (p = 0.03). Doppler echocardiography revealed acute valvar lesions in 10 of 20 rheumatic fever patients who had no auscultatory eviden ce of rheumatic carditis (subclinical carditis). Three of these subclinical lesions and three of the clinical or auscultatory lesions detected on admi ssion were still present after five years of follow up, emphasising that su bclinical lesions are not necessarily transient.; improves the detection of rheumatic Conclusions-Doppler echocardiographic imaging carditis. Subclinical valve l esions, detected only by Doppler imaging, can persist. Echocardiographic fi ndings should be accepted as a major criterion for the diagnosis of rheumat ic fever.