Introduction
Rheumatic heart disease (RHD) is endemic in developing countries
specifically among school-age children. Joint, skin and central nervous
systems might be involved but heart involvement, which can cause
mortality and morbidity, is the most important clinical outcome. Heart
involvement is thought to start from the endocardium and progress
through the pericardium [1]. Another opinion that has been put
forward is that patients diagnosed with RHD can have some degree of
myocardial involvement in general [2]. In patients with cardiac
involvement, the degree and severity of valve involvement can be
diagnosed easily, however it is difficult to identify myocardial
involvement and its severity. When there is pericardial involvement, the
assumption is that there is myocardial involvement as well. In the
absence of pericardial involvement, it is difficult to diagnose
myocardial involvement even with endomyocardial biopsy [3]. To
identify such involvement more advanced diagnostic techniques such as
speckle tracking echocardiography (STE) need to be utilized.
Speckle tracking echocardiography has been shown to be more effective
than the conventional measures of ejection fraction (EF) and shortening
fraction (FS) in evaluating heart functions [4]. Many patients
having heart failure, hypertension, Systemic Lupus Erythematosus,
Duchenne type muscular dystrophy who have been evaluated as normal with
conventional techniques, were identified to have abnormalities in strain
values [5-8].
In this study, we tried to demonstrate that during the acute stages of
rheumatic fever there might be abnormalities due to myocardial
involvement that can be diagnosed with myocardial strain and that these
abnormalities might differ in patients having mild and moderate to
severe carditis and that such abnormalities might disappear after the
treatment period has ended.