Assessment of myocardial involvement using cardiac troponin-I and echocardiography in rheumatic carditis in Izmir, Turkey

Background: Acute rheumatic carditis is still a major problem in developing countries. Cardiac troponin-I (cTnI) has been identified as a sensitive and specific marker in the diagnosis of myocarditis in children and adults. Methods: A prospective study was performed using Doppler echocardiography and cTnI in order to detect myocardial involvement in 26 consecutive patients with acute rheumatic valvular disease. Patients were divided into two groups: group 1, rheumatic fever with carditis (n > 16); group 2, rheumatic fever without carditis (n > 10). Results: Clinically age, gender, body temperature, heart rate and white blood count did not differ significantly between the groups and the age-matched control group. C-reactive protein, erythrocyte sedimentation rate, anti-streptolysin-O were significantly different. Left ventricular fractional shortening was normal in all patients (group 1, 37 ± 10%; group 2, 34 ± 5%; NS). Left ventricular dimensions were larger in group 1, in which all patients except two had moderate to severe mitral and/or aortic valvular regurgitation (5.05 ± 0.75 cm/m2) compared to group 2, in which none had valvular regurgitation (3.27 ± 0.26 cm/m2, P < 0.05). None of the patients in either group presented with or developed pericarditis. Mean cTnI was 0.12 ± 0.034 ng/mL in group 2 and 0.077 ± 0.02 in group 1, the difference of which was not statistically significant. Neither significant cTnI elevations nor echocardiographic systolic function abnormalities were found in the present patients with rheumatic carditis. Conclusions: The present results indicate the absence of myocardial involvement in acute rheumatic carditis without congestive heart failure.