Does rheumatic myocarditis really exists? Systematic study with echocardiography and cardiac troponin I blood levels

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 \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((n=22)\) \end{document}; group 2: patients with carditis and without congestive heart failure \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((n=59)\) \end{document}; group 3: patients with carditis and congestive heart failure \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((n=14)\) \end{document}. 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, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(p=0.09\) \end{document}). 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 \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((p=0.45)\) \end{document}, 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.