Clinical and echocardiographic features of children with rheumatic carditis: correlation with high sensitivity C-reactive protein.

Abstract

Background: Rheumatic fever (RF) and rheumatic heart disease (RHD) are leading causes of cardiovascular mortality and morbidity in developing countries.
Objectives: To describe the clinical and echocardiographic features of children with RF and RHD and compare these features with their serum C-reactive protein in 2 pediatric cardiology centers in Khartoum.
Methodology: It was a prospective cross sectional study. Patients were examined clinically and by echocardiography. Serum high sensitivity C-reactive protein (hsCRP) was measured from children with Acute RF as well as from healthy age and sex matched controls selected from children attending the clinics. Statistical Analysis Used: Mean and standard deviation, P value using Fisher’s exact test.
Results: Sixty six patients (45% males) were enrolled. Mitral regurgitation (MR) was found in 65 patients (98%), it was severe in 42 patients (64%), combined with aortic regurgitation (AR) in 27 patients (41%) and with Mitral stenosis (MS) in 3 patients (4.5%). For patients with carditis, hsCRP ranged between 1.10 and 15 mg/l (mean 8.0817, SD 4.47). In the control group it was 0.6-1.3 mg/l (mean 0.93 SD 0.23) P<0.0001.Patients with Acute RF had hsCRP mean of 12.35 mg/l (SD 2.11) while those with chronic RHD had hsCRP mean of 7.34 mg/l (SD 4.16), P<0.0001.
Conclusion: RHD is manifested in our patients with severe valve damage dominated by MR and there is evidence of an ongoing inflammation during the chronic phase. RHD is manifested in a severe form in Sudan. High sensitivity CRP is elevated in acute phase as well as in the chronic phase.

Key Words: Rheumatic carditis, C-reactive protein.