Ventricular dyssynchrony as a marker of latent carditis in children with acute rheumatic fever: A tissue Doppler imaging

Femoral Artery Sclerosis Evaluation by Tissue Doppler in Patients with Hypertension

Background

The aim of this study was to evaluate the early femoral sclerosis in hypertensive patients by using tissue Doppler imaging (TDI).

Material/Methods

One hundred patients with hypertension were recruited and divided into group A (femoral artery intima-media thicknesses (IMT) ≥1.0 mm) and group B (femoral artery IMT <1.0 mm) with 50 cases in each group based on the femoral IMT. In addition, 50 healthy controls were also included in this study. Femoral wall structure and femoral artery IMT were examined by using high frequency ultrasound. Pulsed wave (PW)-TDI was used to obtain the motion curve of the posterior wall of the femoral artery. First (T1) and second (T2) peak duration were also obtained.

Results

The IMT of group A, group B, and the healthy control group were 1.17±0.12 mm, 0.74±0.11 mm, and 0.71±0.09 mm respectively with significant statistical difference (P<0.05). The first peak duration (T1) of the 3 groups (group A, group B, and healthy control group) were 135.6±16.6 ms, 134.5±18.5 ms, and 129.8±12.4 ms, respectively without statistical difference (F=1.868 P=0.158). The second peak duration (T2) of group A, group B, and the healthy control group were 234.7±39.8 ms, 209.3±34.9 ms, and 169.8±19.5 ms respectively with statistically significant difference (F=50.411 P=0.000). The diagnostic sensitivity, specificity area under the curve (AUC) and cutoff value for early arteriosclerosis diagnosis of femoral artery by T1 was 56.0% (95% CI: 41.3–70.0%), 66.0% (95% CI: 51.2–78.8%), AUC=0.54 (95% CI: 0.42–0.66) and 130.5 ms respectively. And it was 64.0% (95% CI: 49.2–77.1%), 62.0% (95% CI: 47.2–75.4%), AUC=0.69 (95% CI: 0.59–0.80) and 214.5 ms respectively for T2.

Conclusions

TDI can be used as an effective index for early femoral artery sclerosis before femoral artery IMT changes.

Rheumatic fever - new diagnostic criteria

Rheumatic fever (RF) is an autoimmune disease associated with group A β-hemolytic streptococcal infection, in the course of which the patient develops carditis, arthritis, chorea, subcutaneous nodules and erythema marginatum.

Rheumatic fever diagnosis is based on the Jones criteria, developed in 1944, then revised twice by the American Heart Association (AHA), in 1992 and recently in 2015.

The last revision of the Jones criteria consists mainly in the supplementation of the major criteria with echocardiographic examination, the introduction of a concept of subclinical carditis and the isolation of low, medium and high risk populations among the patients.

AHA recommends that all the patients with suspected RF undergo Doppler echocardiographic examination after the Jones criteria have been verified, even if no clinical signs of carditis are present.