CARDIAC TROPONIN-T IN ACUTE RHEUMATIC FEVER

Year 2001, Volume: 14 Issue: 2, 84 - 88, 03.12.2016

Figen Akalın Tamer Ünver Müjdat Başaran

Abstract

Objective: Acute rheumatic fever is still one of
the leading causes of mortality and morbidity due
to heart disease in developing countries. Carditis
is the most important manifestation of the
disease and there are still difficulties in diagnosis.
Cardiac troponin-T measurement has been
found to be valuable in recognition of cardiac
injury in various disease states. We investigated
the cardiac troponin-T levels in patients with
acute rheumatic fever and searched for a
difference between patients with and without
carditis.
Methods: The study group consisted of 21
patients; 12 were girls and 9 were boys. Their
age ranged between 6-16.5 years
(mean±SD=11.9±2.5 yrs). Seven patients had
only arthritis; 10 patients had both carditis and
arthritis; and 4 patients had chorea as clinical
diagnosis. Echocardiographic examination
showed aortic and mitral regurgitation in 7, mitral
regurgitation in 8 and aortic regurgitation in one
patient. Serum levels of creatin phosphokinase
(CK) and MB (CK-MB) fraction and cardiac
troponin-T were measured during the diagnosis
before the initiation of treatment in all patients.
None of the patients had clinically overt
congestive heart failure.
Results: It was observed that CK and CK-MB
levels were increased in one patient with carditis
and arthritis while cardiac troponin-T levels were
below the measurable levels in all patients.
Conclusion: We concluded that cardiac
troponin-T measurement has no value in
detecting the presence of carditis in rheumatic
fever. This may result from absence of
myocardial necrosis despite the presence of
intense myocardial inflammation.
K e y W o r d s : Troponin, Rheumatic fever,
Carditis, Echocardiography

References

• Bitar FF, flayek F, Gharzeddine W, Mikati M, Dbaibo GS. Rheumatic fever in children: A 15- year experience in a developing country. Pediatr Cardiol 2000:21:119-122.
• Mirkinson L. The diagnosis of rheumatic fever. Pediatrics in review 1998; 19:310-311.
• Special writing committee on rheumatic fever, endocarditis and Kawasaki Disease of the council on cardiovascular disease in the
• Figen Akalın, et al
• young of the American Heart Association. Guidelines for the diagnosis of rheumatic fever. JAMA 1992;268:2069-2073.
• Williamson L, Bowness P, Mowat A, Ostman- Smith I. Difficulties in diagnosing acute rheumatic fever-arthritis may be short lived and carditis silent. Br Med J 2000:320:362- 365.
• Vasan RS, Shirivastava S, Vijayakumar M, Ha rag R, Lister B, Harula J. Echocardiographic evaluation of patients with acute rheumatic fever and rheumatic carditis. Circulation 1996;94:73-82.
• Collinson PO. Troponin T or Troponin I or CB- MB (or none?). Eur Heart J 1998:19 (suppl H): H16-H24.
• Hetland O, Dickstein B. Cardiac troponins I and T in patients with suspected acute coronary syndrome: a comparative study in routine setting. Clin Chem 1998:44:1430- 1436.
• Lauer B, Hiederau C, Buhl U, et al. Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol 1997;30:1354- 1359.
• El-Said GM, El-Refaee MM, Sorour BA, El-Said HG. Rheumatic fever and rheumatic heart disease. In: Garson A, Bricker JT, Fisher DJ, Heish SR. eds. The science and practice of pediatric cardiology, 2nd edn. Baltimore, Williams and Wilkins, 1998:1691-1 724.
• Baplan E. Global assessment of rheumatic fever and rheumatic heart disease at the close of century. Circulation 1993;88:1964-1972.
• Veasy LG. Rheumatic fever - T. Duckett Jones and the rest of the story. Cardiol Young 1995:5:293-301.
• Harula J, Chandrasekhar Y, Rahimtoola S. Diagnosis of active rheumatic carditis. Circulation 1999; 100:1576-1581.
• Veasy LG, Wiedmeier SE, Orsmond GS, et al. Resurgence of acute rheumatic fever in the intermountain area of the United States. H Eng J Med 1987;316:421-427.
• Veasy LG, Tani LY, Hill HR. Persistence of acute rheumatic fever in the intermountain area of the united states. J Pediatr 1994;125:673-674.
• Brand A, Doll berg S, Beren A. The prevelance of valvular regurgitation in children with structurally normal hearts: a color Doppler echocardiographic study. Am Heart J 1992,123:177-180.
• Lipshultz SE, Rifai H, Sallan SE, et al. Predictive value of cardiac troponin T in pediatric patients at risk for myocardial injury. Circulation 199 7;96:2641 -2648.
• Hirch R, Landt Y, Porter S. et al. Cardiac troponin I in pediatrics: normal values and potential use in the assessment of cardiac injury. J Pediatr 1997;130:872-877.
• Immer PE, Stocker EP, Seiler AM, Pfammatter JP, Printzen G, Carrel TP. Comparison of troponin I and troponin T after pediatric cardiovascular operation. Ann Thorac Surg 1998;66:2073-2077.
• Panteghini M, Agnoletti G, Pagani F, Spandrio M. Cardiac troponin T in serum as a marker for myocardial injury in newborns. Clin Chem 1997;43:1455-1457.
• Him M, Him B. Elevation of cardiac troponin I in the acute stage of Bawasaki Disease. Pediatr Cardiol 1999:20:184-188.
• Fink FM, Genser H, Fink C, et al. Cardiac troponin-T and creatine Binase MB mass concentrations in children receiving anthrocycline chemotheraphy. Med Pediatr Oncol 1995:25:185-189.
• Harula J, Malhotra A, Yasuda T. Usefulness of antimyosin antibody imaging for the detection of active rheumatic myocarditis. Am J Cardiol 1999;84:946-950.
• Harula J, Chopra P, Talwar BB et al. Does endomyocardial biopsy aid in the diagnosis of active rheumatic carditis? Circulation 1993;88:2198-2205.
• Missov E, Calzolari C, Pau B. Circulating cardiac troponin I in severe congestive heart failure. Circulation 1997:96:2953-2958.