Hostname: page-component-cd9895bd7-dzt6s Total loading time: 0 Render date: 2024-12-25T03:12:47.350Z Has data issue: false hasContentIssue false
  • English
  • Français

QT dispersion in acute rheumatic fever

Published online by Cambridge University Press:  22 March 2006

Tugcin Bora Polat ,
Yalim Yalcin ,
Celal Akdeniz ,
Cenap Zeybek ,
Abdullah Erdem  and
Ahmet Celebi
Tugcin Bora Polat
Affiliation:
Department of Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Yalim Yalcin
Affiliation:
Department of Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Celal Akdeniz
Affiliation:
Department of Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Cenap Zeybek
Affiliation:
Department of Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Abdullah Erdem
Affiliation:
Department of Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Ahmet Celebi
Affiliation:
Department of Pediatric Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Hospital, Istanbul, Turkey
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Disturbances of conduction are well known in the setting of acute rheumatic fever. The aim of this study is to investigate the QT dispersion as seen in the surface electrocardiogram of children with acute rheumatic fever. Methods: QT dispersion was quantitatively evaluated in 88 children with acute rheumatic fever. Patients were divided into two groups based on the absence or presence of carditis. As a control group, we studied 36 healthy children free of any disease, and matched for age with both groups. Repeat echocardiographic examinations were routinely scheduled in all patients at 3 months after the initial attack to study the evolution of valvar lesions. Results: The mean QT dispersion was significantly higher in children with rheumatic carditis. But there was no statistical difference between children without carditis and normal children. Among the children with carditis, the mean dispersion was higher in those with significant valvar regurgitation. Dispersion of greater than 55 milliseconds had a sensitivity of 85%, and specificity of 70%, in predicting rheumatic carditis, while a value of 65 milliseconds or greater had sensitivity of 81% specificity of 85% in predicting severe valvar lesions in acute rheumatic carditis. At follow-up examination, a clear reduction on the QT dispersion was the main finding, reflecting an electrophysiological improvement. Conclusions: These observations suggest that QT dispersion is increased in association with cardiac involvement in children with acute rheumatic fever.

Keywords

ElectrocardiographycarditisJones, criterions
Type
Original Article
Information
Cardiology in the Young , Volume 16 , Issue 2 , April 2006 , pp. 141 - 146
Copyright
© 2006 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Nordet P. WHO/ISFC Global Programme for the prevention and control of RF/RHD. J Int Soc Fed Cardiol 1993; 3: 4–5.Google Scholar
Eisenberg MJ. Rheumatic heart disease in the developing world: prevalence, prevention and control. Eur Heart 1993; 14: 122–128.Google Scholar
Da Silva NA, Pereira BA. Acute rheumatic fever. Still a challenge. Rheum Dis Clin North Am 1997; 23: 545–568.Google Scholar
Barr CS, Naas A, Freeman M, Lang CC, Struthers AD. QT Dispersion and sudden unexpected death in chronic heart failure. The Lancet 1994; 343: 327–329.Google Scholar
Merx W, Yoon MS, Han J. The role of local disparity in conduction and recovery time on ventricular vulnerability to fibrillation. Am Heart J 1977; 94: 603–610.Google Scholar
Fei L, Statters DJ, Camm AJ. QT-interval dispersion on 12-lead electrocardiogram in normal subjects: its reproducibility and relation to the T wave. Am Heart J 1994; 127: 1654–1655.Google Scholar
Kautzner J, Yi G, Camm AJ, Malik M. Short and long term reproducibility of QT, QTc, and QT dispersion measurement in healthy subjects. Pace 1994; 17: 928–937.Google Scholar
Linker NJ, Colonna P, Kekwick CA, Till J, Camm AJ, Ward DE. Assessment of QT dispersion in symptomatic patients with congenital long QT syndromes. Am J Cardiol 1992; 69: 634–638.Google Scholar
Zareba W, Moss AJ, IeCessie S. Dispersion of ventricular repolarization and arrhythmic death in coronary artery disease. Am J Cardiol 1994; 74: 550–553.Google Scholar
Buja G, Miorelli M, Turrini P, Melacini P, Nava A. Comparison of QT dispersion in hypertrophic cardiomyopathy between patients with and without ventricular arrhythmias and sudden death. Am J Cardiol 1993; 72: 973–976.Google Scholar
Grimm W, Steder U, Menz V, Hoffman J, Maisch B. QT dispersion and arrhythmic events in idiopathic dilated cardiomyopathy. Am J Cardiol 1996; 78: 458–461.Google Scholar
Daliento L, Caneve F, Turrini P, et al. Clinical significance of high-frequency, low-amplitude electrocardiographic signals and QT dispersion in patients operated on tetralogy of Fallot. Am J Cardiol 1995; 76: 408–411.Google Scholar
Durakovic Z, Durakovic A, Korsic M. Changes of the corrected Q-T interval in the electrocardiogram of patients with anorexia nervosa. Int J Cardiol 1994; 45: 115–120.Google Scholar
Committee on Rheumatic Fever and Bacterial Endocarditis of the American Heart Association. Jones' criteria (revised) for guidance in the diagnosis of rheumatic fever. Circulation 1984; 69: 203–208.
World Health Organization. Rheumatic fever and rheumatic heart disease: report of a WHO study group. Geneva, Switzerland: World Health Organization 1988; 5–58. WHO Technical Report Series 764.
Special Writing Group of the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease of the Council of Cardiovascular Disease in the Young of the American Heart Association. Guidelines for the diagnosis of rheumatic fever: Jones' criteria, 1992 update. JAMA 1992; 268: 2069–2073.
Feinstein AR, Spagnuolo M. Mimetic features of rheumatic fever recurrences. N Engl J Med 1960; 262: 533–535.Google Scholar
Roy SB. The management of rheumatic fever. J Indian Med Assoc 1960; 35: 453–455.Google Scholar
Brand A, Dollberg S, Keren A. The prevalence of valvular regurgitation in children with structurally normal hearts: a color Doppler echocardiographic study. Am Heart J 1992; 123: 177–180.Google Scholar
Sahn DJ, Maciel BC. Physiological valvular regurgitation: Doppler echocardiography and the potential for iatrogenic heart disease. Circulation 1988; 78: 1075–1077.Google Scholar
Helmcke F, Nanda NC, Hsiung MC, et al. Color Doppler assessment of mitral regurgitation with orthogonal planes. Circulation 1987; 75: 175–183.Google Scholar
Perry GJ, Helmcke F, Nanda NC, Byard C, Soto B. Evaluation of aortic insufficiency by Doppler color flow mapping. J Am Coll Cardiol 1987; 9: 952–959.Google Scholar
Bazett HC. An analysis of the time-relations of electrocardiograms. Heart 1920; 7: 353.Google Scholar
Sanyal SK, Thapar MK, Sharma DB, Shrivastava OP. Atrioventricular conduction in children with acute rheumatic fever. Am J Dis Child 1976; 130: 473–476.Google Scholar
Higham PD, Hilton CJ, Aitcheson DA, Furniss SS, Bourke JP, Campbell RWF. QT dispersion does reflect regional variation in ventricular recovery. Circulation 1992; 86 (Suppl I): I-392.Google Scholar
Macfarlane PW, McLaughlin SC, Rodger JC. Influence of lead selection and population on automated measurement of QT dispersion. Circulation 1998; 98: 2160–2167.Google Scholar
Tutar HE, Ocal B, Imamoglu A, Atalay S. Dispersion of QT and QTc interval in healthy children, and effects of sinus arrhythmia on QT dispersion. Heart 1998; 80: 77–79.Google Scholar
Pye MP, Cobbe SM. Mechanisms of ventricular arrhythmias in cardiac failure and hypertrophy. Cardiovasc Res 1992; 26: 740–750.Google Scholar
Zalzstein E, Maor R, Zucker N, Katz A. Advanced atrioventricular conduction block in acute rheumatic fever. Cardiol Young 2003; 13: 506–508.Google Scholar
Galinier M, Vialette JC, Fourcade J, et al. QT interval dispersion as a predictor of arrhythmic events in congestive heart failure. Importance of aetiology. Eur Heart J 1998; 19: 1054–1062.Google Scholar
Fu GS, Meissner A, Simon R. Repolarization dispersion and sudden cardiac death in patients with impaired left ventricular function. Eur Heart J 1997; 18: 281–289.Google Scholar
Essop MR, Wisenbaugh T, Sareli P. Evidence against a myocardial factor as the cause of left ventricular dilation in active rheumatic carditis. J Am Coll Cardiol 1993; 22: 826–829.Google Scholar
Narula J, Chopra P, Talwar KK, et al. Does endomyocardial biopsy aid in the diagnosis of active rheumatic carditis? Circulation 1993; 88: 2198–2205.Google Scholar