Turk Kardiyol Dern Ars. 2005; 33(8): 460-466

Clinical and echocardiographic correlations in rheumatic fever: evaluation of the diagnostic role of auscultation

H.Ercan Tutar¹, Nazire Özçelik¹, Semra Atalay¹, Emel Derelli¹, Filiz Ekici¹, Ayten İmamoğlu¹

OBJECTIVES
The diagnosis of rheumatic carditis with auscultation can be difficult especially in subclinical cases. We investigated the effectiveness of auscultation in detecting valvular regurgitation in rheumatic fever (RF).
STUDY DESIGN
The study included 112 patients (51 males, 61 females; mean age 11.0±2.4 years; range 6 to 16 years) with RF (n=75) and rheumatic heart disease (n=37). The presence of murmurs of mitral (MR) and aortic (AR) regurgitation on precordial auscultation were noted. Two-dimensional and color Doppler echocardiographic examinations were performed in all the patients to determine pericardial effusions, prolapse and thickening of the mitral valve, and pathologic valvular regurgitations. The sensitivity, specificity, and predictive values of auscultation were calculated for MR and AR.
RESULTS
Seventy-seven patients had cardiac involvement (68.8%; 47 mild, 13 moderate, 17 severe), which was demonstrated by auscultation in 60 patients (77.9%). There were 17 patients with silent carditis. Auscultation enabled detection of MR and AR in 60 (60/72; 83.3%) and 21 (21/37; 56.8%) patients, respectively. Echocardiography revealed silent MR in 12 patients and silent AR in 16 patients. The degree of valvular insufficiency was significantly lower in silent cases than those with evident MR (p=0.003) and AR (p=0.005). Of 12 patients with silent MR, only one patient had mitral valve prolapse and another had thickening of the mitral valve. The sensitivity, specificity, positive and negative predictive values of auscultation were found as 83.3%, 85.0%, 90.9% and 73.9% for MR, and 56.8%, 98.7%, 95.5% and 82.2% for AR, respectively.
CONCLUSION
Auscultation was found to be more sensitive for MR and more specific for AR. Given considerably low negative predictive value of auscultation for MR and AR, the role of echocardiographic examination to detect cardiac involvement is indispensable in patients with RF.

Keywords: Child; echocardiography, Doppler; heart auscultation; heart valve diseases; mitral valve insufficiency/ultrasonography; myocarditis; rheumatic fever/diagnosis; rheumatic heart disease

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