Evaluation of plasma gelsolin level and carotid intima-media thickness in patients with acute rheumatic fever

Summary: Acute rheumatic fever (ARF) is an autoimmune disease which is the most significant cause of acquired heart diseses in children in underdeveloped and developing countries. Juvenile rheumatoid arthritis and systemic lupus erythematosus have been shown to cause different outcomes in plasma gelsolin levels in some rat studies. In our study, demographic features, electrocardiographic findings, and also clinical and laboratuary findings of patients diagnosed with acute rheumatic fever have been studied prospectively, and plasma gelsolin levels of patients during acute attack have been investigated. Method: Our study is a prospective one. A total of 44 patients aged 5-18, who have applied to Yüzüncü Yıl University Medical School Pediatric Cardiology Clinic between August 2016 and September 2018 and diagnosed with ARF according to 2015 Modified Jones Criteria (2 major or 1 major + 2 minor) (Table 1), have been included in our study. Patients' blood samples have been taken and studied for plasma gelsolin levels immediately upon diagnosis of ARF. As the control group; children of the same age group and gender, who have applied to the general children's clinic between the same dates as the study group and have no chronic disease, have been selected. Findings: Average age was 11 ± 3.1 in the patient group and 10.7 ± 3.2 in the control group; and there was no meaningful difference between the groups in that sense. 26 patients (59%) were female and 18 (41%) were male in the study group. In the control group, there were 19 (%54) females and 16 (%46) males. In the patient group, there were 15 (34%) patients who had only arthritis and no carditis. In 2 (4,5%) patients there was only isolated carditis, whereas in 27 patients (61,5%) arthritis and carditis existed together. Carotid Doppler USG parameters have been analyzed for the risk of atherosclerosis in both the study and the control group. There was no meaningful difference between the study group and the control group in terms of CAS, CAD and CIMT. KAdÇ and KAsÇ were significantly higher in the patient group when compared to the control group. In the evaluation performed using M-mode and two dimensional ECHO, no meaningful difference was observed between two groups in terms of left ventricular end-systolic diameter (LVesD) and MAPSE. Left ventricular posterolateral wall thickness (LVpWD), left ventricular end-diastolic diameter (LVedD) and IVS were meaningfully higher in the patient group compared to the control group. When evaluated with KDE, no meaningfull difference observed between the gropus in terms of S, DT and İVRT. In the patient group, E, A, İVCT and MPI values were significantly higher, whereas ET and E/A rates were lower compared to the control group. In the analysis of tissue Doppler echocardiography performed through mitral annulus lateral; statistically no difference was observed between two groups in terms of E', S', İVRT', E'/A' and MPİ'. In the patient group, A', DT', E/E' and İVCT' values were meaningfully higher, whereas ET' was lower compared to the control group. Conclusion: We found that in patients with ARF; as the indicators of heart's diastolic dysfunction, parameters of LVedD, E and A increases while E/A, E/E' and ET time decreases. Also İVCT time, which indicates heart's diastolic dysfunction, elongates in this group. Furthermore, we observed that MPİ, İVS and LVpWD parameteres, which indicates both systolic and diastolic dysfunction of heart, increases in the patient group. Gelsolin levels may increase or decrease in many types of diseases. In our study, gelsolin levels were meaningfully higher in the patient group. Gelsolin levels were observed to be similar between the group that had only arthritis and the group that had carditis + arthritis together. We need larger and multi-centered studies on patients of those groups. It is observed that the increased gelsolin level is correlated with the diastolic dysfunction of the left heart. In ARF patients who has only arthritis, we observed the existence of subclinical cardiac affection. When evaluating CIMT using cartoid Doppler USG, we found that CAS and CAD values are similar in both the ARF patient group and the control group. Keywords: Acute Rheumatic Fever, Plasma Gelsolin Level, Carotid Intima-Media Thickness, Echocardiography