(Circulation. 1999;100:1576-1581.)
© 1999 American Heart Association, Inc.
Current Perspective |
Diagnosis of Active Rheumatic Carditis
The Echoes of Change
From the Division of Cardiovascular Diseases (J.N.), Hahnemann University School of Medicine, Philadelphia, Pa; University of Minnesota School of Medicine (Y.C.), Minneapolis, Minn; and University of Southern California (S.R.), Los Angeles, Calif.
Correspondence to Jagat Narula, MD, PhD, Heart Failure/Transplant Center, Hahnemann University Hospital, Broad & Vine, Mail Stop 115, Philadelphia, PA 19102. E-mail Narula@auhs.edu
Key Words: rheumatic heart disease • endocarditis • mitral regurgitation • arthritis • streptococcal infections
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Not everything that counts can be counted, and not everything that can be counted counts. Albert Einstein
Acute rheumatic fever (RF) continues to be a major health problem at the dawn of the new millennium in many parts of the world.1 2 3 Rheumatic heart disease (RHD), the sequel of RF, is a very common cause of cardiovascular mortality and morbidity,1 2 3 4 5 accounts for 35% to 40% of cardiovascular disease-related hospital admissions, and is the predominant indication for cardiac surgery in developing countries.1 6 Although traditionally considered to be a disease associated with poverty and overcrowding, RF continues to persist, even among the prosperous middle-class population in developed countries.7 8 9
Although RF is a systemic disease with multiorgan involvement, none of
its manifestations, except for carditis, lead to permanent damage.
Clinical cardiac involvement has been reported in nearly one-third to
almost all patients with RF in various series and in up to 50%
of patients in prospective studies.10 Detection of active
rheumatic carditis is of great prognostic and therapeutic importance
and is currently based on the Jones criteria. Not infrequently, the
diagnosis of carditis by the Jones criteria becomes difficult,
especially when carditis is the isolated manifestation of the disease
or when the rheumatic activity occurs on preexisting
RHD.11 12 13 It is important to develop a
diagnostic strategy that will improve our ability to
diagnose rheumatic carditis and allow us to apply existing criteria
more efficiently.13 14 The advent of modern, highly
sensitive cardiac imaging modalities, predominantly
echocardiography/Doppler ultrasound
(echo-Doppler), has raised the question whether the
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