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.