Arquivos Brasileiros de Cardiologia (Jan 2006)
Estudo comparativo das avaliações clínica e ecocardiográfica Doppler na evolução das lesões valvares em crianças e adolescentes portadores de febre reumática Comparative study of clinical and Doppler echocardiographic evaluations of the progression of valve diseases in children and adolescents with rheumatic fever
Abstract
OBJETIVO: Comparar os exames clínico e ecocardiográfico Doppler na avaliação das lesões valvares em crianças e adolescentes com febre reumática, bem como investigar a evolução da doença segundo essas avaliações. MÉTODOS: Trata-se de estudo observacional longitudinal que englobou 258 crianças e adolescentes com diagnóstico de febre reumática, baseado nos critérios de Jones. Os pacientes foram acompanhados durante o período de 2 a 15 anos. A presença e a quantificação das lesões valvares nas fases aguda e crônica foram determinadas pelas avaliações clínica e ecocardiográfica Doppler. Utilizou-se a estatística de Kappa para estimar a concordância entre as avaliações, e as evoluções clínica e ecocardiográfica Doppler da cardite e valvite, respectivamente, foram comparadas pelo teste do qui-quadrado ou de Fisher, p OBJECTIVE: Compare clinical and Doppler echocardiographic evaluations in assessing valvular diseases in children and adolescents with rheumatic fever, as well as assess the progression of the disease in light of these assessments. METHODS: This is a longitudinal study of 258 children and adolescents diagnosed with rheumatic fever according to Jones’ criteria. The follow-up period ranged from 2-15 years. The presence and quantification of valve diseases were determined by means of clinical and Doppler echocardiographic evaluations performed during the acute and chronic phases. The Kappa statististics method was used to estimate the degree of agreement between clinical and Doppler echocardiographic evaluations. Comparisons between clinical and Doppler echocardiographic findings on the progress of carditis and valvulitis, respectively, were made using chi-square test or Fisher’s exact test, p< 0.05. RESULTS: Of the 109 patients who underwent Doppler echocardiographic evaluation during the acute phase, 31 did not present clinical evidence of carditis, but the Doppler echocardiograms of 17 (54.8%) of them showed valve lesions (subclinical valvulitis). During the chronic phase, 153 of the 258 patients had normal cardiovascular examination results; however, Doppler echocardiograms showed that 81 of them (52.9%) had valve lesions (subclinical chronic valvular diseases). Involution of the valvular lesions, as shown by Doppler echocardiographic evaluations, was less frequent and occurred in 10 (25.0%) patients with mild valvulitis, in only one (2.5%) patient with moderate valvulitis, and in none of the patients with severe valvulitis. CONCLUSION: The identification of rheumatic fever valve lesions can be enhanced when clinical evaluations are supplemented by Doppler echocardiographic examinations; also, clinical examinations are not as suitable to detect valvular lesion regression as the echocardiography. The diagnosis of subclinical valvulitis and valvulopathy influences the secondary prophylaxis of rheumatic fever and endocarditis.
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