Abstract

Objective. Rheumatic heart disease (RHD) is the most common cause of acquired heart disease in developing countries and remains a serious public health problem. In the subclinical course of carditis, the absence of typical symptoms and the normal range of classical echocardiographic measurements used to evaluate cardiac functions have required new echocardiographic methods and parameters. Previous studies regarding rheumatic heart disease in children and adults have shown that strain patterns obtained by speckle tracking echocardiography, are in fact affected although left ventricular systolic functions are preserved, yet some studies have suggested otherwise. The aim of our study is to compare the use of speckle tracking echocardiography with conventional methods in the evaluation of cardiac functions and myocardial involvement in children with subclinical RHD.

Materials and Methods. The study group consisted of 24 patients with asymptomatic cardiovascular who had no history of acute rheumatic fever, but had definite or probable rheumatic valve disease. This study group was determined according to the World Heart Federation guidelines by an echocardiographic examination performed for different reasons, as well as the control group of 22 healthy children. In order to evaluate the left ventricular regional myocardial functions of the patients, tissue Doppler echocardiography (TDE) and speckle tracking echocardiographic parameters were compared with the control group.

Results. The mean ages of the patient and control groups were 14.1±2.7 years and 13.9±2.3 years, respectively. There was no statistically significant difference between the two groups in terms of conventional methods (p>0.05) but global longitudinal strain and strain rate values were found to be significantly lower in the patient group (p<0.01). These changes appeared to be relevant throughout the duration of the illness.

Conclusion. In patients with subclinical rheumatic heart disease, conventional echocardiographic evaluations are likely negative, whereas two-dimensional speckle tracking echocardiography reveal systolic and diastolic dysfunctions of the disease.

Keywords: children, speckle tracking echocardiography, rheumatic heart disease

Copyright and license

Copyright © 2024 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Bal HI, Türkyılmaz İ, Kayalı Ş, Kılıç A. Subtle myocardial effects of rheumatic heart disease in children are revealed earlier with two-dimensional speckle tracking echocardiography. Turk J Pediatr 2024; 66: 346-353. https://doi.org/10.24953/turkjpediatr.2024.4566

References

  1. Seckeler MD, Hoke TR. The worldwide epidemiology of acute rheumatic fever and rheumatic heart disease. Clin Epidemiol 2011; 3: 67-84. https://doi.org/10.2147/CLEP.S12977
  2. Monaghan MJ. Role of real time 3D echocardiography in evaluating the left ventricle. Heart 2006; 92: 131-136. https://doi.org/10.1136/hrt.2004.058388
  3. Mor-Avi V, Lang RM, Badano LP, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 2011; 12: 167-205. https://doi.org/10.1093/ejechocard/jer021
  4. Altman M, Bergerot C, Aussoleil A, et al. Assessment of left ventricular systolic function by deformation imaging derived from speckle tracking: a comparison between 2D and 3D echo modalities. Eur Heart J Cardiovasc Imaging 2014; 15: 316-323. https://doi.org/10.1093/ehjci/jet103
  5. Reményi B, Wilson N, Steer A, et al. World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease-an evidence-based guideline. Nat Rev Cardiol 2012; 9: 297-309. https://doi.org/10.1038/nrcardio.2012.7
  6. Harrington JK, Ferraro AM, Colan SD, et al. Normal left ventricular systolic and diastolic strain rate values in children derived from two-dimensional speckle-tracking echocardiography. J Am Soc Echocardiogr 2021; 34: 1303-1315.e3. https://doi.org/10.1016/j.echo.2021.07.013
  7. Remenyi B, Carapetis J, Wyber R, Taubert K, Mayosi BM; World Heart Federation. Position statement of the World Heart Federation on the prevention and control of rheumatic heart disease. Nat Rev Cardiol 2013; 10: 284-292. https://doi.org/10.1038/nrcardio.2013.34
  8. Roberts K, Cannon J, Atkinson D, et al. Echocardiographic screening for rheumatic heart disease in indigenous Australian children: a cost-utility analysis. J Am Heart Assoc 2017; 6: e004515. https://doi.org/10.1161/JAHA.116.004515
  9. Migrino RQ, Aggarwal D, Konorev E, Brahmbhatt T, Bright M, Kalyanaraman B. Early detection of doxorubicin cardiomyopathy using two-dimensional strain echocardiography. Ultrasound Med Biol 2008; 34: 208-214. https://doi.org/10.1016/j.ultrasmedbio.2007.07.018
  10. Saxena A. Increasing detection of rheumatic heart disease with echocardiography. Expert Rev Med Devices 2014; 11: 491-497. https://doi.org/10.1586/17434440.2014.930661
  11. Dorobantu DM, Wadey CA, Amir NH, Stuart AG, Williams CA, Pieles GE. The role of speckle tracking echocardiography in the evaluation of common inherited cardiomyopathies in children and adolescents: a systematic review. Diagnostics (Basel) 2021; 11: 635. https://doi.org/10.3390/diagnostics11040635
  12. Sobhy R, Samir M, Abdelmohsen G, et al. Subtle myocardial dysfunction and fibrosis in children with rheumatic heart disease: insight from 3D echocardiography, 3D speckle tracking and cardiac magnetic resonance imaging. Pediatr Cardiol 2019; 40: 518-525. https://doi.org/10.1007/s00246-018-2006-5
  13. Pamuk U, Gürsu HA, Azak E, Çetin İİ. Assessment of myocardial mechanics in acute rheumatic fever using speckle-tracking echocardiography. Anatol J Cardiol 2023; 27: 592-596. https://doi.org/10.14744/AnatolJCardiol.2023.1792
  14. Lawrence JG, Carapetis JR, Griffiths K, Edwards K, Condon JR. Acute rheumatic fever and rheumatic heart disease: incidence and progression in the Northern Territory of Australia, 1997 to 2010. Circulation 2013; 128: 492-501. https://doi.org/10.1161/CIRCULATIONAHA.113.001477
  15. Saxena A, Ramakrishnan S, Roy A, et al. Prevalence and outcome of subclinical rheumatic heart disease in India: the RHEUMATIC (Rheumatic Heart Echo Utilisation and Monitoring Actuarial Trends in Indian Children) study. Heart 2011; 97: 2018-2022. https://doi.org/10.1136/heartjnl-2011-300792
  16. Zhang W, Mondo C, Okello E, et al. Presenting features of newly diagnosed rheumatic heart disease patients in Mulago Hospital: a pilot study. Cardiovasc J Afr 2013; 24: 28-33. https://doi.org/10.5830/CVJA-2012-076
  17. Vasan RS, Shrivastava S, Vijayakumar M, Narang R, Lister BC, Narula J. Echocardiographic evaluation of patients with acute rheumatic fever and rheumatic carditis. Circulation 1996; 94: 73-82. https://doi.org/10.1161/01.cir.94.1.73
  18. Zühlke L, Engel ME, Karthikeyan G, et al. Characteristics, complications, and gaps in evidence-based interventions in rheumatic heart disease: the Global Rheumatic Heart Disease Registry (the REMEDY study). Eur Heart J 2015; 36: 1115-1122. https://doi.org/10.1093/eurheartj/ehu449
  19. Cantinotti M, Marchese P, Scalese M, et al. Normal values and patterns of normality and physiological variability of mitral and tricuspid inflow pulsed doppler in healthy children. Healthcare (Basel) 2022; 10: 355. https://doi.org/10.3390/healthcare10020355
  20. Levy PT, Machefsky A, Sanchez AA, et al. Reference ranges of left ventricular strain measures by two-dimensional speckle-tracking echocardiography in children: a systematic review and meta-analysis. J Am Soc Echocardiogr 2016; 29: 209-225. https://doi.org/10.1016/j.echo.2015.11.016
  21. Koopman LP, Rebel B, Gnanam D, Menting ME, Helbing WA, Boersma E. Reference values for two-dimensional myocardial strain echocardiography of the left ventricle in healthy children. Cardiol Young 2019; 29: 325-337. https://doi.org/10.1017/S1047951118002378
  22. Beaton A, Richards H, Ploutz M, et al. Cardiac strain findings in children with latent rheumatic heart disease detected by echocardiographic screening. Cardiol Young 2017; 27: 1180-1185. https://doi.org/10.1017/S1047951116002778