Echocardiographic evidence of silent carditis in asymptomatic children with elevated antistreptolysin O titers: a cross-sectional study
Sümeyye Koç, Derya ArslanAbstract
Objectives:
Carditis, the main determinant of long-term morbidity in acute rheumatic fever, may be detected by echocardiography even in the absence of clinical signs. This study aimed to determine the prevalence of silent carditis in asymptomatic children with elevated antistreptolysin O titers and to evaluate associations with demographic and laboratory parameters.
Methods:
In this cross-sectional study, 61 asymptomatic children with incidentally detected elevated antistreptolysin O titers between September 2020 and September 2021 were evaluated. Demographic characteristics, inflammatory markers, and standardised Doppler echocardiographic assessments based on World Heart Federation criteria were analysed.
Results:
Silent carditis was identified in 8 of 61 patients (13.1%; 95% confidence interval 6.9 to 23.3). In the silent carditis group, 75% were female, and the median age was 12 years (interquartile range 9 to 14). Echocardiographic findings showed isolated mitral regurgitation in four patients and combined mitral and aortic regurgitation in four. Erythrocyte sedimentation rate was the only parameter that differed significantly between patients with and without silent carditis ( p = 0.001). Antistreptolysin O levels showed weak negative correlations with haemoglobin (rho = −0.322, p = 0.011) and left ventricular posterior wall thickness (rho = −0.270, p = 0.036).
Conclusions:
Some asymptomatic children with elevated antistreptolysin O titers had echocardiographic findings consistent with silent carditis. However, antistreptolysin O levels and most inflammatory markers were not reliable predictors of valvular involvement. Echocardiography in selected cases may help detect subclinical cardiac involvement. Findings should be interpreted cautiously due to the limited sample size and cross-sectional design.