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Abstract

Pericardial Effusion in Acute Rheumatic Fever and Rheumatic Heart Disease †

by
Tehmina Kazmi
1,
Omeir Aziz
1,
Humera Javed
1,
Ansar Nawaz
1,
Ndate Fall
2,
Craig Sable
1 and
Masood Sadiq
1,*
1
University of Child Health Sciences, The Children’s Hospital Lahore, Lahore 54600, Pakistan
2
Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA
*
Author to whom correspondence should be addressed.
†
Presented at the 22nd Lancefield International Symposium on Streptococci and Streptococcal Diseases, Brisbane, Australia, 1–5 June 2025.
Proceedings 2025, 124(1), 22; https://doi.org/10.3390/proceedings2025124022
Published: 15 August 2025
(This article belongs to the Proceedings of The 22nd Lancefield International Symposium on Streptococci and Streptococcal Diseases (LISSSD 2025))
Versions Notes

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.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Kazmi, T.; Aziz, O.; Javed, H.; Nawaz, A.; Fall, N.; Sable, C.; Sadiq, M. Pericardial Effusion in Acute Rheumatic Fever and Rheumatic Heart Disease. Proceedings 2025, 124, 22. https://doi.org/10.3390/proceedings2025124022

AMA Style

Kazmi T, Aziz O, Javed H, Nawaz A, Fall N, Sable C, Sadiq M. Pericardial Effusion in Acute Rheumatic Fever and Rheumatic Heart Disease. Proceedings. 2025; 124(1):22. https://doi.org/10.3390/proceedings2025124022

Chicago/Turabian Style

Kazmi, Tehmina, Omeir Aziz, Humera Javed, Ansar Nawaz, Ndate Fall, Craig Sable, and Masood Sadiq. 2025. "Pericardial Effusion in Acute Rheumatic Fever and Rheumatic Heart Disease" Proceedings 124, no. 1: 22. https://doi.org/10.3390/proceedings2025124022

APA Style

Kazmi, T., Aziz, O., Javed, H., Nawaz, A., Fall, N., Sable, C., & Sadiq, M. (2025). Pericardial Effusion in Acute Rheumatic Fever and Rheumatic Heart Disease. Proceedings, 124(1), 22. https://doi.org/10.3390/proceedings2025124022

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