Can subclinical valvitis detected by echocardiography be accepted as evidence of carditis in the diagnosis of acute rheumatic fever?

Aim: Subclinical valvar insufficiency, or valvitis, has recently been ident ified using Doppler echocardiography in cases of acute rheumatic fever with isolated arthritis or chorea. The prognosis of such patients with acute rh eumatic fever and subclinical valvitis is critical when determining the dur ation of antibiotic prophylaxis. We aimed, therefore, prospectively to inve stigate the association of silent valvitis in patients having rheumatic fev er in the absence of clinical evidence of cardiac involvement, and to evalu ate its prognosis. Methods and Results: Between November 1998 and September 1999, we identified 26 consecutive patients with silent valvitis in presen ce of rheumatic fever but in the absence of clinical signs of carditis. The patients, eight female and 18 male, were aged from 6 to 16 years, with a m ean of 9.9+/-2.7 years. Major findings were arthritis in 16, chorea in 7, a nd arthritis and erythema marginatum in 1 patient. Two cases had arthralgia with equivocal arthritic signs and Doppler echocardiographic findings of p athologic mitral regurgitation. Silent pathologic mitral regurgitation was found in 12 cases, and aortic regurgitation in 2 cases. All patients with a rthritic findings were treated with acetylsalicylic acid with one exception , this patient receiving both prednisone and acetylsalicylic acid. No antii nflammatory treatment was given to patients with chorea. After a mean follo w-up of 4.52 months, valvar regurgitation disappeared in 4 patients, includ ing the one with migratory arthralgia and no other major criterions. All si x patients with chorea and silent carditis still have mitral insufficiency. Conclusion: Acute rheumatic fever without clinical carditis is not a benig n entity. Doppler echocardiographic findings of subclinical valvar insuffic iency, therefore, should be considered as carditis when seeking to establis h the diagnosis of acute rheumatic fever.