الفهرس 
Rheumatic FeverOnly 14 pages are availabe for public view
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Abstract
Acute rheumatic fever (ARF) is the sequel of untreated oropharyngeal infection by group A hemolytic Streptococcus. The most common manifestations are carditis, arthritis and chorea. Rheumatic heart disease (RHD) is a progressive valvulopathy that occurs in approximately 60% of those patients with ARF. The primary cardiac phenotype is valvulopathy, with the mitral valve most often affected and the aortic valve the next most
common (Yanagawa, 2016).
The evaluation of contractile function with echocardiography has traditionally been limited to volume based assessment of global systolic function with ejection fraction (EF) and of segmental wall motion or visual estimation of regional thickening. These methods have suffered from lack of reproducibility and standardization and are generally considered to be extremely sensitive to loading conditions. These limitations have led to an interest in techniques that provide more objective and reproducible measures of contractile function. Deformation imaging allows for a more direct evaluation of myocardial changes through the cardiac cycle by speckle tracking analysis (Nascimento et al., 2016).
In the last decade new echocardiographic modalities, such as strain (deformation) analysis, have been developed, which is considered one of the methods for quantifying global and regional myocardial function and can detect regional systolic dysfunction at an earlier subclinical stage than conventional echocardiography (Gunjan, 2012). Strain is currently measured by two methods: tissue Doppler imaging and speckle-tracking echocardiography. The latter method enables the assessment of strain
parameters in different directions and rotational LV function (Mizarienė et
al., 2012).
Myocardial deformation imaging with echocardiography can be performed with the use of either tissue Doppler-based or 2-dimensional (2D) speckle tracking based methods. Speckle tracking analysis offers the advantage of an objective quantitative assessment of regional and global myocardial function, not affected by insonation angle, cardiac translational movements, with a good interobserver and intraobserver reproducibility, because of its semi-automated feature (Rosa et al., 2016).
Speckle tracking analysis evaluates strain that can be described as the systolic change in length of a myocardial segment relatively to its length at rest, so expressed as a percentage (Rosa et al., 2016).
Presence of inflammatory cells and increased expression of several cytokines in cases of chronic rheumatic heart disease reflects a possible sub- clinical, ongoing insult or inflammation to some unrecognized antigenic stimulus by beta hemolytic streptococcal antigens that have sensitized/primed the various target tissues and that further culminate in permanent valve damage. This low-grade ongoing inflammation is a marker for subsequent cardiovascular disease. It leads to lipid peroxidation and increases the risk of atherosclerosis (Habeeb and Al Hadidi, 2011).
The aim of this work is to study regional myocardial deformation in rheumatic heart disease patients using 2D strain and its relation to high- sensitivity C-reactive protein (CRP) as a marker of chronic inflammation.
The study was performed at the Pediatric Cardiology Clinic and echocardiography unit, Children’s hospital, Ain Shams University from June
2014 to February 2016 on 40 patients with chronic rheumatic heart disease
(group I), 20 patients with history of arthritis or chorea (group II) and 40 age and sex matched children as a control group (group III).
All patients and controls were subjected to:
• Thorough Medical History: laying stress on Age, sex, duration of illness, history of acute rheumatic fever, long acting penicillin prophylaxis, symptoms of acute rheumatic fever, cardiac symptoms including
symptoms of heart failure and any medication receive
• Thorough clinical examination: with emphasis on: Weight, height, blood pressure and pulse rate. All measurements were compared to normal centiles for age and sex and described as increased, decreased or normal.
Cardiac examination for detection of abnormal heart sounds, the presence of gallop rhythm or murmurs and signs of rheumatic activity (WHO, 2009).
• Assessment of serum hs-CRP level using a latex-enhanced immunonephelometer (Dade Behring; Netwark, DE) and measured by ELISA.
• Routine 2D echocardiography to delineate cardiac chamber dimensions and presence of pulmonary hypertension. M-mode echocardiography to assess left atrial and left ventricular dimensions and LV systolic
function. Also continuous, pulsed and color Doppler echocardiography to identify and describe the regurgitant flow of the affected valves. Left ventricular 2D strain to evaluate global and regional LV longitudinal strain (by using device model GE medical system VIVID E9 dimensions N-3190 Horten NORWAY).