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Left ventricular mechanics during and after acute rheumatic fever: contractile dysfunction is closely related to valve regurgitation

Thomas L. Gentles, FRACP^{* b,,d}, Steven D. Colan, MD, FACC^,d, Nigel J. Wilson, MRCP^{* b}, Renelle Biosa^{* b} and John M. Neutze, MD, FRACP^{* b,d}

^* Department of Pediatric Cardiology, Green Lane Hospital, Auckland, New Zealand
^b Departments of Pediatrics and Medicine, University of Auckland, Auckland, New Zealand
Department of Cardiology, Children’s Hospital, Boston, Massachusetts, USA
^d Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA

View larger version (26K): [in a new window]   Figure 1 Left ventricular end-systolic wall stress-velocity of shortening relationships during acute rheumatic fever. The shaded area demarcated by the solid line indicates the normal range (mean ± 2 standard deviations). The dashed lines indicate extrapolation of the relationship to abnormal levels of end-systolic wall stress. Group I = no or mild aortic or mitral regurgitation; group II = moderate or severe aortic or mitral regurgitation (see text for details). ESSc = circumferential end-systolic wall stress; VCFC = rate corrected velocity of circumferential fiber shortening.

View larger version (22K): [in a new window]   Figure 2 (A) Velocity of shortening-end-systolic wall stress relationship by regurgitant valve during acute rheumatic fever in group II patients. The shaded area indicates the normal range. (B) The stress-velocity relationships for the same patient group derived from (A). Large symbols and bars = mean ± one standard deviation. p values are derived from comparison with the normal population and between the two valve groups using the Newman-Keuls multiple comparison test (see text for details). AR = aortic regurgitation; ESSc = circumferential end-systolic wall stress; MR = mitral regurgitation; VCFC = rate corrected velocity of circumferential fiber shortening.