Abstract 13147: Non-invasive Identification of Carditis in Acute Rheumatic Fever and Rheumatic Heart Disease

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sarah J Gutman ◽  
Benedict T Costello ◽  
Melissa G van Leeuwen ◽  
Jessica O'Brien ◽  
Seeba E Varghese ◽  
...  
Keyword(s):  
Heart Disease ◽  
Acute Rheumatic Fever ◽  
T1 Mapping ◽  
Healthy Controls ◽  
Z Score ◽  
Z Scores ◽  
Myocardial T1 ◽  
The Mean ◽  
Native T1 Time ◽  
Rheumatic Heart

Background: The pathogenesis of acute rheumatic fever (ARF) and its evolution into rheumatic heart disease (RHD) is poorly understood. We aimed to identify carditis in patients with ARF and RHD using cardiac magnetic resonance (CMR) tissue characterisation with T1 mapping. We hypothesised that prolonged native T1 time on CMR, would be present in ARF and RHD patients. Methods: We prospectively recruited 62 patients. We recruited 16 patients fulfilling the Jones Criteria for the diagnosis of ARF, 15 controls with an inflammatory condition and 10 healthy controls. We also recruited 11 patients with echocardiographic evidence of RHD and 10 matched controls. All patients underwent CMR with assessment of non-contrast myocardial T1 mapping. The myocardial T1 time, as an index of myocardial inflammation from carditis, was compared between the groups. All T1 times were converted to Z-scores, to enable comparison with different CMR systems. Findings: Patients with ARF had evidence of carditis demonstrated by markedly elevated mean myocardial T1 times. The mean Z score was 2.76(95% CI 1.34-4.17) for patients with ARF compared to 0.32(95% CI -0.25-0.88) for those with non-cardiac inflammatory conditions and 0.00(95% CI -0.72-0.72) for healthy controls, P=0.004. A myocardial T1 Z score greater than 1.4 showed excellent diagnostic performance as a single test for the diagnosis of ARF (AUC = 0.85[0.67-0.99], P=0.001, sensitivity = 82 %, specificity = 92%, Youden’s J = 0.74). Patients with RHD also demonstrated significantly elevated native T1 time compared to matched controls. The mean Z score for RHD patients was 2.79(95% CI 1.3-4.3) compared to 0.00(95% CI -0.72-0.72) in controls, P=0.002. Interpretation: Patients with ARF and RHD have markedly elevated myocardial T1 Z-scores on CMR, consistent with carditis. Incorporating CMR T1 mapping into the diagnostic algorithm for ARF may improve diagnostic certainty and lead to more effective delivery of secondary penicillin prophylaxis.

Acute rheumatic fever in the paediatric population: a descriptive study in the Malaysian state of Sabah

2021 ◽  
pp. 1-5
Author(s):  
Farul R Patel ◽  
Jason Wy Tan ◽  
Siva Rao
Keyword(s):  
Heart Disease ◽  
Rheumatic Fever ◽  
Rheumatic Heart Disease ◽  
Acute Rheumatic Fever ◽  
Paediatric Population ◽  
Disease Registry ◽  
Male Patients ◽  
The Mean ◽  
Time Of Presentation ◽  
Rheumatic Heart

Abstract Introduction: Rheumatic heart disease is among the leading causes of acquired valvular heart disease in the developing world. However, there is no data available for rheumatic heart disease in the paediatric population of Sabah. This study collected data for acute rheumatic fever admissions among the paediatric population in Sabah over a period of 3 years. Methods: This is a retrospective cohort study. All records for admissions to paediatric wards in Sabah for acute rheumatic fever from January 2016 to December 2018 were collected. The patient records were then traced and required information were collected. Results: A total of 52 cases of acute rheumatic fever were admitted. It was observed that the incidence of acute rheumatic fever was 74.4 per 100,000 paediatric admissions. Patients from the West Coast Division made up most of the admissions (n = 24, 46.2%). Male patients (n = 35, 67.3%) of the indigenous Kadazan-Dusun ethnicity (n = 21, 40.4%) were most commonly encountered. The mean age at time of presentation was 9.58 years. Most cases admitted (n = 38, 73.1%) were categorised as Priority 1 (severe rheumatic heart disease). Conclusion: Most patients who were admitted had symptoms of heart failure and were diagnosed with severe rheumatic heart disease. Although this disease is preventable, the incidence in Sabah remains high. This study was limited as we only looked at patients who were admitted and we foresee the real incidence to be higher. Hence, there is an urgent need for a rheumatic heart disease registry in Malaysia to gather more data for prevention and early intervention.

Comparison of myocardial T1 mapping during breath-holding and free-breathing

2021 ◽  
pp. 1-5
Author(s):  
Hideharu Oka ◽  
Kouichi Nakau ◽  
Sadahiro Nakagawa ◽  
Yuki Kobayashi ◽  
Rina Imanishi ◽  
...  
Keyword(s):  
Cross Sections ◽  
T1 Mapping ◽  
Free Breathing ◽  
Breath Holding ◽  
Basal Region ◽  
Analysis Method ◽  
Imaging Analysis ◽  
Myocardial T1 ◽  
The Mean ◽  
Almost All

Abstract Background: T1 mapping is a recently developed imaging analysis method that allows quantitative assessment of myocardial T1 values obtained using MRI. In children, MRI is performed under free-breathing. Thus, it is important to know the changes in T1 values between free-breathing and breath-holding. This study aimed to compare the myocardial T1 mapping during breath-holding and free-breathing. Methods: Thirteen patients and eight healthy volunteers underwent cardiac MRI, and T1 values obtained during breath-holding and free-breathing were examined and compared. Statistical differences were determined using the paired t-test. Results: The mean T1 values during breath-holding were 1211.1 ± 39.0 ms, 1209.7 ± 37.4 ms, and 1228.9 ± 52.5 ms in the basal, mid, and apical regions, respectively, while the mean T1 values during free-breathing were 1165.1 ± 69.0 ms, 1103.7 ± 55.8 ms, and 1112.0 ± 81.5 ms in the basal, mid, and apical regions, respectively. The T1 values were lower during free-breathing than during breath-holding in almost all segments (basal: p = 0.008, mid: p < 0.001, apical: p < 0.001). The mean T1 values in each cross section were 3.1, 7.8, and 7.7% lower during free-breathing than during breath-holding in the basal, mid, and apical regions, respectively. Conclusions: We found that myocardial T1 values during free-breathing were about 3–8% lower in all cross sections than those during breath-holding. In free-breathing, it may be difficult to assess myocardial T1 values, except in the basal region, because of underestimation; thus, the findings should be interpreted with caution, especially in children.

scholarly journals Mean Levels of B-type Natriuretic Peptide (BNP) in Patients with Mitral Stenosis Caused by Rheumatic Heart Disease

2021 ◽  
pp. 96-102
Author(s):  
Altaf Hussain ◽  
Faraz Farooq Memon ◽  
Iftikhar Ahmed ◽  
Syed Ahsan Raza ◽  
Lajpat Rai ◽  
...  
Keyword(s):  
Heart Disease ◽  
Rheumatic Heart Disease ◽  
Natriuretic Peptide ◽  
Mitral Stenosis ◽  
Final Analysis ◽  
Severe Intensity ◽  
The Mean ◽  
Valvular Lesion ◽  
Rheumatic Heart ◽  
Valve Area

Objective: Mitral stenosis caused by rheumatic heart disease (RHD) is the most common cause of valvular lesion in adults and prevalent in developing countries like Pakistan. Higher natriuretic peptide (BNP) levels can be observed in patients with moderate to severe untreated mitral stenosis and are associated with higher rates of morbidity and mortality. That is why this study aims to determine the association between levels of pro-BNP with severity (mild. Moderate, and severe) of mitral stenosis. Patients and Methods: This was a clinical prospective study carried out in the department of adult cardiology, national institute of cardiovascular diseases, Karachi from 8th august 2019 to 7th February 2020. Total 68 patients of either gender with age between 25-70 years had mitral stenosis of moderate to severe intensity (mitral valve area ≤1.5 cm2), diagnosed on echocardiography were included for final analysis. A simple blood sample was taken for the assessment of pro-BNP levels. Questionnaire was used for demographic & clinical data collection and analysed using SPSS version 22.0. Results: The overall mean age of study subjects was 42.21±11.50 years, ranging from 25 – 70 years. Among them, females were prevalent (n = 43, 63.2%). The overall mean serum BNP level was 1071.12±807.26 pg/ml and the mean difference of serum BNP level was not significant among groups of gender, age, and diabetes mellitus with p>0.05. Significantly raised levels of BNP were observed in patients with severe mitral stenosis as compared to moderate mitral stenosis, p<0.05 Conclusion: In conclusion, the mean BNP levels were higher in patients with severe Mitral Stenosis. Therefore, BNP may be used to complement the clinical and echocardiographic assessments in patients with Mitral Stenosis.

Sign in / Sign up

Export Citation Format

Share Document