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.
Author Contributions
Conceptualization, T.K. and M.S.; methodology, T.K.; validation, O.A., H.J. and N.F.; formal analysis, T.K.; investigation, T.K.; resources, N.F.; data curation, T.K.; writing—original draft preparation, T.K.; writing—review and editing, T.K., M.S., O.A., H.J., A.N., C.S. and N.F.; visualization, T.K. and M.S.; supervision, M.S.; project administration, M.S. All authors have read and agreed to the published version of the manuscript.
Funding
This study was conducted under the infrastructure of the ARC network that is funded by Leducq Foundation.
Institutional Review Board Statement
The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Boards of Brazil, Malawi, Pakistan, and Timor-Leste.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study. For participants under the age of 18 years, consent was obtained from a parent or guardian.
Data Availability Statement
Data are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
Conflicts of Interest
The authors declare no conflict of interest.
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