Background. Rheumatic heart disease (RHD) is a leading cause of heart failure in children and young adults worldwide. B-type natriuretic peptide (BNP) is a useful marker of critical pediatric heart disease, and its N-terminal peptide, NT-proBNP, is elevated in congenital and acquired heart disease in children. Aim. To measure NT-proBNP levels as a marker of carditis in children with acute rheumatic carditis, as compared to children with quiescent RHD and healthy controls. Methods. 16 children with acute rheumatic carditis, 33 children with quiescent RHD, and a cohort of 30 healthy children were studied. Transthoracic echocardiography was performed to assess valve and cardiac function. Tissue Doppler echocardiography was performed for E/E′ (ratio between mitral inflow E wave and lateral mitral annulus E′ wave) and systolic strain. Results. NT-proBNP levels were significantly higher in children with acute rheumatic carditis and dropped with its resolution. Strain and E/E′ values were comparable among the three groups. Conclusion. NT-proBNP is significantly elevated in children with acute rheumatic carditis in the acute stage compared to children with quiescent RHD and healthy subjects, in the presence of comparable echocardiographic indices of LV systolic and diastolic function. 1. Introduction Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) continue to be a major health problem in developing countries, and RHD is the leading cause of heart failure in children and young adults worldwide, resulting in disability and premature death [1]; 80–85% of children younger than 15 years live in areas where rheumatic heart disease is endemic [2]. Late diagnosis is prejudicial since a bout of ARF is a therapeutic emergency. While polyarthritis is the initial and most common major manifestation, carditis is the most serious manifestation of ARF [3] and occurs in around a half of patients [4–9] within 3 weeks of onset of ARF [3]. Although the initial attack can lead to severe valvular disease, ARF might be insidious at onset, and RHD most often results from cumulative valve damage due to recurrent episodes of ARF with a paucity of clinical symptoms [1, 10, 11]. Given that the efficacy and safety of antibiotic prophylaxis are well established and should lead to near complete eradication of advanced RHD when combined with broader changes such as improved living conditions, education, and awareness [12–14], early detection of acute rheumatic carditis will allow appropriate initiation of secondary prophylaxis. No diagnostic method exists that detects onset of
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