Doppler Echocardiography Imaging in Detecting Multi-Valvular Lesions: A Clinical Evaluation in Children with Acute Rheumatic Fever

Pushpa Shivaram, Molla Imaduddin Ahmed, Pramod Theetha Kariyanna, Harika Sabbineni, Uma Mahesh R. Avula

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Rationale:Doppler echocardiography has been demonstrated to be accurate in diagnosing valvular lesions in rheumatic heart disease (RHD) when compared to clinical evaluation alone.Objective:To perform Doppler echocardiography in children clinically diagnosed by the Jones criteria to have acute rheumatic fever (ARF), and to then compare the effectiveness of echo in detecting single/multi-valvular lesions with that of the initial clinical evaluation.Methods and Results:We enrolled 93 children who were previously diagnosed with ARF by clinical examination. Presence of valvular lesions were enlisted, first by clinical auscultation, and then by performing Doppler echocardiography. We found that Doppler echocardiography was a sensitive technique, capable of detecting valvular lesions that were missed by clinical auscultation alone. Echocardiography of patients with carditis revealed mitral regurgitation to be the most common lesion present (53 patients, 56.98%), followed by aortic regurgitation in 21 patients (22.6%). The difference between clinical and echocardiographic diagnosis in ARF children with carditis was statistically significant for mitral regurgitation, aortic regurgitation and tricuspid regurgitation. Clinical auscultation alone revealed 4 cases of mitral stenosis, 39 mitral regurgitation, 14 aortic regurgitation, 9 tricuspid regurgitation; in contrast, echo revealed 5 cases of mitral stenosis, 53 mitral regurgitation, 21 aortic regurgitation, 18 tricuspid regurgitation.Conclusion:Doppler echocardiography is a more sensitive technique for detecting valvular lesions. In the setting of ARF, echo enables a 46.9% higher detection level of carditis, as compared to the clinical examination alone. Echo was very significant in detecting regurgitation lesions, especially for cases of tricuspid regurgitation in the setting of multivalvular involvement. The results of our study are in accordance with previous clinical studies, all of which clearly demonstrate the advantages of Doppler echocardiography, paving the way for its probable inclusion as one of the Jones major criteria for diagnosing ARF.

Original languageEnglish (US)
Article numbere74114
JournalPloS one
Volume8
Issue number9
DOIs
StatePublished - Sep 16 2013

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Echocardiography
Rheumatic Fever
Doppler Echocardiography
echocardiography
fever
Tricuspid Valve Insufficiency
Aortic Valve Insufficiency
Mitral Valve Insufficiency
image analysis
Imaging techniques
Auscultation
Myocarditis
myocarditis
Mitral Valve Stenosis
clinical examination
Rheumatic Heart Disease
heart diseases
clinical trials
methodology

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Doppler Echocardiography Imaging in Detecting Multi-Valvular Lesions : A Clinical Evaluation in Children with Acute Rheumatic Fever. / Shivaram, Pushpa; Ahmed, Molla Imaduddin; Kariyanna, Pramod Theetha; Sabbineni, Harika; Avula, Uma Mahesh R.

In: PloS one, Vol. 8, No. 9, e74114, 16.09.2013.

Research output: Contribution to journalArticle

Shivaram, Pushpa ; Ahmed, Molla Imaduddin ; Kariyanna, Pramod Theetha ; Sabbineni, Harika ; Avula, Uma Mahesh R. / Doppler Echocardiography Imaging in Detecting Multi-Valvular Lesions : A Clinical Evaluation in Children with Acute Rheumatic Fever. In: PloS one. 2013 ; Vol. 8, No. 9.
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abstract = "Rationale:Doppler echocardiography has been demonstrated to be accurate in diagnosing valvular lesions in rheumatic heart disease (RHD) when compared to clinical evaluation alone.Objective:To perform Doppler echocardiography in children clinically diagnosed by the Jones criteria to have acute rheumatic fever (ARF), and to then compare the effectiveness of echo in detecting single/multi-valvular lesions with that of the initial clinical evaluation.Methods and Results:We enrolled 93 children who were previously diagnosed with ARF by clinical examination. Presence of valvular lesions were enlisted, first by clinical auscultation, and then by performing Doppler echocardiography. We found that Doppler echocardiography was a sensitive technique, capable of detecting valvular lesions that were missed by clinical auscultation alone. Echocardiography of patients with carditis revealed mitral regurgitation to be the most common lesion present (53 patients, 56.98{\%}), followed by aortic regurgitation in 21 patients (22.6{\%}). The difference between clinical and echocardiographic diagnosis in ARF children with carditis was statistically significant for mitral regurgitation, aortic regurgitation and tricuspid regurgitation. Clinical auscultation alone revealed 4 cases of mitral stenosis, 39 mitral regurgitation, 14 aortic regurgitation, 9 tricuspid regurgitation; in contrast, echo revealed 5 cases of mitral stenosis, 53 mitral regurgitation, 21 aortic regurgitation, 18 tricuspid regurgitation.Conclusion:Doppler echocardiography is a more sensitive technique for detecting valvular lesions. In the setting of ARF, echo enables a 46.9{\%} higher detection level of carditis, as compared to the clinical examination alone. Echo was very significant in detecting regurgitation lesions, especially for cases of tricuspid regurgitation in the setting of multivalvular involvement. The results of our study are in accordance with previous clinical studies, all of which clearly demonstrate the advantages of Doppler echocardiography, paving the way for its probable inclusion as one of the Jones major criteria for diagnosing ARF.",
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