| dc.description.abstract | Sir,
Vijayalakshmi and her colleagues are to be
commended for their paper.1 We disagree, however,
with the use of a scoring system to make an
echocardiographic diagnosis of carditis due to acute
rheumatic fever. We agree with the comments of
Nigel Wilson in the accompanying editorial,2
namely that the finding of significant mitral
regurgitation in isolation, giving a score of 2 rather
than the minimum of 6 in their system, should
underscore the diagnosis of subclinical carditis
in acute rheumatic fever. The patients described
by the authors both in their recent paper,1 and
in their earlier publication in 2005,3 were surely
suffering predominantly from recurrent attacks,
given the extent of the valvar disease described in
the paper. The valvar lesions they describe differ
from those reported in patients, also from India, by
Vasan and colleagues,4 recognising that the echocardiographic machines used by Vasan and associates were from a different technological era. It
should also be noted that Caldas and colleagues,5
albeit working in a different continent, observed
mitral regurgitation without concomitant thickening of the valve in only 3 of 11 patients with
subclinical carditis.
We would suggest that a scoring system similar
to that proposed by Vijayalakshmi and colleagues1
would be more appropriate for the detection of
subclinical cardiac lesions in populations known
to be at high risk of rheumatic fever. The use
of a standardized score would allow meaningful
comparison between studies published from different areas of high prevalence, as well as an accurate
way of measuring temporal change, especially if a
population-based intervention, such as aggressive
treatment of sore throats, were to be tested over a
decade or more.
We would also recommend that an attempt
should be made to use the highest frequency probe
possible for every patient. In our own experience,
current technology allows for the use of 7 MHz
probes even in thin patients aged around 10 years.
Use of such probes would potentially avoid overdiagnosis of valvar thickening or nodular change.
We endorse the comments of Vijayalakshmi and
colleagues,1 nonetheless, on the caveats in the use of
harmonic imaging, particularly with the default
setting of high-end machines, since we agree that it
can be easy to over-diagnose valvar thickness if this
modality is selected during a study | en_US |
