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European Heart Journal 2003 24(9):855-862; doi:10.1016/S0195-668X(02)00825-4
Copyright © 2003 by the European Society of Cardiology.
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Does rheumatic myocarditis really exists? Systematic study with echocardiography and cardiac troponin I blood levels

Joel Kamblocka,*, Laurent Payota, Bernard Iungb, Philippe Costesa, Tristan Gilleta, Christophe Le Goanvica, Philippe Lioneta, Bruno Pagisa, Jerome Paschec, Christine Royd, Alec Vahanianb and Gérard Papouina

a Centre de Cardiologie du Taaone, Pirae, Tahiti, French Polynesia
b Département de Cardiologie, Groupe Hospitalier Bichat-Claude-Bernard, Assistance Publique-Hôpitaux de Paris, Paris, France
c Service de Pédiatrie, Centre Hospitalier Mamao, Tahiti, French Polynesia
d Service de Biochimie, Centre Hospitalier Mamao, Tahiti, French Polynesia

* Corresponding author. Tel.: +689-77-22-77; fax: +689-46-46-17
E-mail address: kamblock{at}mail.pf

Received 18 November 2002; accepted 20 November 2002

Aims Revised guidelines for diagnosis of rheumatic fever indicate that rheumatic myocarditis may ‘contribute’ to the genesis of congestive heart failure. Our objective was to assess non-invasively the presence of non-clinical markers of myocardial involvement in acute rheumatic fever.

Methods Echocardiography and assessment of cardiac troponin I (cTnI) blood levels were systematically performed in 95 consecutive patients with acute rheumatic fever, who were divided into three groups. Group 1: patients without carditis ; group 2: patients with carditis and without congestive heart failure ; group 3: patients with carditis and congestive heart failure .

Results Left ventricular ejection fraction was normal in all patients and did not differ between groups (group 1: 0.72±0.08, group 2: 0.69±0.06, and group 3: 0.66±0.07, ). Left ventricular diameters tend to be larger in group 3, but all patients had severe mitral and/or aortic regurgitation. Mean cTnI was 0.077±0.017ng/ml (normal <0.1ng/ml), did not differ between groups , and only 13 patients (seven with pericardial effusion) had detectable levels (0.2–0.4ng/ml).

Conclusions Our study neither detected cTnI elevations nor echocardiographic abnormalities suggesting significant myocardial involvement during rheumatic fever. Congestive heart failure was always associated to severe valve regurgitation.

Key Words: Troponin • Rheumatic fever • Echocardiography • Myocarditis


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