ABSTRACT

Objective: Acute rheumatic fever (ARF) is an autoimmune disorder associated with beta-hemolytic streptococcus infection (Group A). While acute carditis is the most significant manifestation of the disease, its involvement typically occurs on the skin, in the joints, heart, and central nervous system. Additionally, B-type natriuretic peptide (BNP) is an important myocardial function and prognosis marker. In this study, we examine the BNP levels in a children’s cohort who were diagnosed with ARF clinical signs.

Material and Methods: All patients with ARF were enrolled in Pediatric Cardiology. Thirty-three patients, aged 5-15 years (mean age 11.06 ± 2.18 years), with ARF, were examined, and their findings were compared to 41 children (mean age; 10.78 ± 2.87 years) who had previously developed ARF, as well as an additional 43 children (mean age; 9.53 ± 2.99 years) who had pain but no systemic and congenital heart disease. Furthermore, ARF patients were also assessed in subgroups such as carditis, chorea, and arthritis. Doppler echocardiographic examination was performed on all the patients. Pro-BNP levels were measured in patients with ARF after diagnosis and before treatment, and they were compared with patients who had previously had ARF and control groups upon admission. Pro-BNP levels were measured with a chemiluminescent assay. Comparisons were analyzed with variance analysis (ANOVA), post-hoc Tukey HSD, t-test analysis, and Pearson correlation.

Results: The Pro-BNP values were 308.18 ± 402.65 pg/ml in patients with active ARF while Pro-BNP values were 84 ± 135.75 pg/ml, 64.82 ± 50.37 pg/ml in patients who previously had ARF and control group, respectively (p< 0.001). Pro-BNP values were higher in active carditis patients than in other subgroups. A positive correlation was found between Pro-BNP and ASO, CRP, ESR, and thrombocytes whereas there was a negative correlation between BNP and hemoglobin. Pro-BNP values decreased significantly with active carditis (101.12 ± 100.01 pg/ml) after treatment (p= 0.003).

Conclusion: Unlike other cardiac enzymes, Pro-BNP revealed a statistical correlation with acute phase reactants, platelet count, and antistreptolysin O (ASO). Thus, this study proved that an increased Pro-BNP might be helpful for diagnosing patients with inflammation and cardiac involvement.

Keywords: Acute rheumatic fever, Pro-BNP, congestive heart failure, child