Pericardial Effusion in Acute Rheumatic Fever and Rheumatic Heart Disease

Background: Pericardial effusion in ARF has been described in 5-10% of patients, but contemporary data is sparse.The ARC diagnostic network is a multi-site collaborative effort to identify diagnostic biomarkers for ARF.This collaborative presents a unique opportunity to assess the incidence and the relationships between ARF, RHD, and pericardial effusion.Methods: Cases were recruited from 4 sites (Pakistan, Brazil, Malawi, Timor-Leste).Echocardiograms were transferred to a cloud server (Trice) and underwent adjudication by a panel of global experts.Presence and severity of pericardial effusion was assessed.Clinical outcomes including hospitalization and death were recorded.Descriptive statistics were used for the analysis.Results: A total of 203 children with ARF and 180 with RHD form the study group.Of these 39 (10.2%) had a pericardial effusion; 23 (11%) of ARF and 16 (9%) of RHD.The median age was 12 (10-13.5)years and 21 (54%) were females.The case distribution was as follows: Pakistan (21/206, 11%), Malawi (14/93, 15%), Brazil (1/44, 2%), and Timor-Leste (3/40, 7.5%).It was mild in 35 (90%) and moderate to large in 4 (10%) cases.All children with pericardial effusion were associated with moderate-to-severe valve disease (39/39, 100%), when compared with children with no pericardial effusion and moderate-to-severe disease (227/344, 66%), p < 0.001.Hospitalization was required in 26 (67%) patients, and there were 2 (5%) deaths.Conclusions: Pericardial effusion may be a manifestation of severe valvar heart disease and not a purely inflammatory component of ARF.Follow-up studies are needed to see the long-term outcome.